Account Resolution Rep I

5000 Wellstar Medical Group, LLC; Georgia; Hybrid; USD 40,000 - 56,000; Full time

Job summary

Wellstar Health System, Inc. is seeking a Day Shift Billing/Revenue Cycle Specialist in Georgia to join a team focused on accurate claim processing and patient-centered service.

You will collect and resolve payments from insurers, execute denial appeals, research payer issues, and prepare reports while maintaining patient privacy and compliance with regulatory standards. Strong communication and organizational skills are essential as you collaborate with clinicians, payers, and patients to

Qualifications

• High school diploma required or equivalent.
• Minimum 2 years collection experience.
• Excellent communication skills with patients, families, and colleagues.
• Strong math, problem-solving and analytical abilities.
• Detail-oriented with good organizational skills and ability to handle heavy workload.
• Able to follow policies and procedures and maintain confidentiality.

Responsibilities

• Collect and resolve payments from insurance companies per policy.
• Execute denial appeals process, documenting and resolving appeals with payers.
• Research payer denials and ensure accuracy of accounts and claims.
• Prepare and submit required reports.
• Report recurring issues to management and suggest process improvements.
• Ensure all payer contacts are documented in the main software.
• Meet productivity and quality standards and support revenue cycle goals.
• Communicate professionally with patients and colleagues.

Skills

Excellent communication skills

Math & analytical ability

Problem solving

Self-directed

Education

High school diploma

Job description

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift Day (United States of America) Duties and Responsibilities

• Collect and resolve payments from insurance companies by working with assigned payers and utlizing Policies and Procedures.
• Execute the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner.
• Research and resolve payer rejected/denied claims and analyze accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract. Work with clinical staff as needed to follow-up and appeal denials.
• Prepare, maintain, assist with, and submit reports as required.
• Appropriately report on-going problems specific to health system departments, and/or contracts to Team Manager or Team Lead.
• Provide feedback and process improvement ideas to management regarding facility, Patient Access, Case Management, HIM, Billing and/or payer issues identified when reviewing accounts for resolution.
• Appeal in accordance with methodology in departmental policy and procedure including using correct grammar and spelling.
• Identify contract issues related to denials and delayed adjudication; communicate those issues to Manager.
• Transmit required documentation to Government and third-party payers for the purpose of resolving payments.
• Ensure all payer contact is fully documented in the appropriate software application.
• Ensure claims are crossed over to secondary insurances, reporting any delay in unbilled secondary claims to your Lead.
• Consistently meet the current productivity standards in addressing and resolving accounts.
• Consistently meet the current quality standards in taking appropriate actions to identify and track root causes, successfully appeal denied accounts, and trend issues.

Teamwork

• Provide individual contribution to the overall team effort of achieving the department AR goal
• Identify opportunities for system and process improvement and submit in team meetings
• Become cross-trained and fill in for other staff as assigned
• Particpate and encourage team collaboration and unity.
• Initiate communication with peers about changes and procedures, convey new relevant information to other team members and management.

Administrative

• Professional Communication
• Assure patient privacy and confidentiality as appropriate or required
• Communicate in a professional manner with patients, their families and representatives from third party payor organizations, physicians and their staff, co-workers and management.
• Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies
• Interact with internal customers including HIM, Revenue Integrity, Patient Access, and the SBO in a professional manner to achieve revenue cycle department AR goals and objectives
• Department Methods/Procedures/Operations
• Follow department guidelines for lunch, breaks, requesting time off, and shift assignments
• Operate office equipment and machinery and utilizes ergonomic workstations, equipment, and supplies
• Follow JCAHO and outside regulatory agencies’ mandated rules and procedures
• Utilize assigned menus and pathways in the mainframe system. Report software application problems to the appropriate source.
• Utilize assigned computer hardware. Report hardware problems to the appropriate source.
• Participate in the testing for assigned software applications, including verification of field integrity when needed.
• Perform other duties and responsibilities as assigned

Qualifications Required

• High school diploma Required or equivalent
• Minimum 2 years collection experience
• Ability to perform mathematical calculations with High-level problem solving, analytical, and investigational skills Excellent communication skills when dealing with patients, families, public, co-workers, and professional offices including oral and written comprehension and expression Basic experience and knowledge of PC applications Detail-oriented, good organizational skills, and ability to be self-directed Strong time management skills; Ability to learn quickly and meet continuous timelines, managing multiple priorities and a heavy workload in a high-stress atmosphere Demonstrate flexibility to perform other tasks as needed in an active work environment with changing work needs Ability and willingness to exhibit behaviors consistent with principles of excellent service Ability and willingness to demonstrate and maintain competency as required for job title and the unit/area(s) of assignment Ability and willingness to exhibit behaviors consistent with standards of performance improvement and organizational values (e.g., efficiency & financial responsibility, safety, partnership & service, teamwork, compassion, integrity, & respect)

Join us and discover the support to do more meaningful work-and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.

Nationally ranked and locally recognized for our high-quality care and inclusive culture, Wellstar is one of Georgia’s largest and most integrated healthcare systems. Every day, 24,000+ of us work together to provide personalized care for patients at every age and stage of life - and our team members are the foundation of that care.

Mission, Vision & Values

OUR MISSION: To enhance the health and well-being of every person we serve.

OUR VISION: Deliver world-class healthcare to every person, every time.

OUR VALUES: We serve with compassion We pursue excellence We honor every voice

Culture of Excellence Wellstar consistently receives attention and accolades from national organizations that set the standards for world-class care. Our system-wide practice of safety principles, assessing and addressing errors and seeking feedback from our patients and customers continually earns recognition for advances in safety and quality. Featured on the FORTUNE “100 Best Companies to Work For” list and Seramount 100 Best Companies list, we not only provide top-notch care for our patients, but also foster the culture of Wellstar as a Great Place to Work.