Systems Accounts Resolution Analyst

At Bristol Health, we begin each day caring today for your tomorrow.  We have been an integral part of our community for the past 100 years. We are dedicated to providing the best possible care and service to our patients, residents and families.  We are committed to provide compassionate, quality care at all times and to uphold our values of Communication, Accountability, Respect and Empathy (C.A.R.E.).   We are Magnet ® and received the 2020 Press Ganey Leading Innovator award for our rapid adoption and implementation of healthcare solutions during the COVID-19 pandemic.  Use your expertise, compassion, and kindness to transform the patient experience.  Make a difference.  Make Bristol Health your choice.  

Job Summary

In a hospital and/or professional office environment, the Insurance Representative is responsible for analysis, investigation and resolution of patient and insurance balances as a result of a call, inquiry to a specific department, payer electronic specifics.

Essential Job Functions and Responsibilities:

• Contacts insurance carriers to facilitate payments, review underpayments and denials. Refer difficult accounts to denials team for further action
• Identifies barriers to efficient departmental operations related to self-pay billing/trends in insurance denial and takes an active role in developing appropriate solutions
• actively works daily work queue and clearing house denials
• Assists the self-pay follow up team in areas such processing financial assistance applications, payment plans through third party vendor, preparing patient refund requests, processing bankruptcy notifications, return mail, etc

• Reviews payer bulletins to stay current on updates.
• Communicates with departments and Coding Vendor to resolve claim issues.
• Responds and takes action related to calls, emails, and faxes related to patient billing in a timely and professional manner
• Uses a patient-centric approach to answer questions and provide information in a professional manner
• Understands all payer regulations to effectively communicate with patients about charges, payments and adjustments on their account
• Investigates patient inquiries/disputes surrounding charging, coding, payments, locations, services, insurance coverage, etc
• Works with individuals when appropriate at various levels of the organization to find resolution on patient disputes
• Updates account information (addresses, insurances, etc.) and rebills as appropriate to initiate the next steps in the billing and collection cycle
• Communicate effectively and works directly with third party self pay vendor and relays updates on patient accounts timely
• Reviews procedural and diagnostic coding of claims to assure maximum reimbursement.
• Direct Management of insurance AR and meet Corporate standards

Educational / Minimum Requirements:

High School Diploma or equivalent experience

At least three (3) years of revenue cycle experience including insurance and self-pay billing, remit processing, patient access and/or collections experience in hospital or physician office setting

Fluent in English is required

Excellent customer service and communication as well as interpersonal, organizational and analytical skills

Comprehensive knowledge of Professional and Hospital revenue cycle.

Ability to work in a high volume setting and respond to patient inquiries in a timely manner

Ability to identify and communicate payer and/or system trends

Ability to navigate system payer websites

Knowledge of payer contracts, regulations and guidelines, as well as State and Federal laws relating to billing, collection, and financial assistance procedures preferred

Familiar with medical and insurance terminology

Proficient in the use of a computer and relevant hospital software applications ie: Eclinical Works and Meditech

Understanding and adherence to HIPAA Regulations and Release of Information Rules

Models teamwork through cooperation and collaboration within and outside the work group

Ability to attain productivity and quality standards per department requirements

State/Federal Mandated Licensure or Certification Requirements:

None.

Bristol Hospital Mandated Educational Requirements:

General orientation at time of hire. Fire/Safety/Infection Control annually. Other programs as mandated by Hospital.

Special Requirements:

Adapts at PC use - computer keyboard with minimum error.

Physical Requirements:

Must maintain daily flexibility including but not limited to sitting and standing.  Requires continual use of computer screen access and data input requiring dexterity and movement.  Ability to efficiently move about the Business Office to retrieve and seek information necessary to decision make is required.  Vision and hearing corrected to normal is essential.

Work Environment:

Normal office conditions.

Cognitive Requirements:

Must be able to think independently, analyze information, execute written and oral instructions, follow directions, speak, write and understand English and have good mathematical aptitude.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.