Patient Account Resolution Specialist

Houston Methodist; Tennessee; On-site; USD 52,000 - 65,000; Full time

Job summary

Houston Methodist is seeking a Patient Account Resolution Specialist to promptly resolve troubled accounts requiring special handling such as uninsured and VIP cases.

The role involves reviewing full revenue cycle elements, applying critical thinking for patient-centric solutions, and interacting with patients, physicians, and hospital staff to ensure accurate billing and resolution. Strong communication and analytical skills are essential.

Qualifications

• Demonstrates the skills and competencies necessary to safely perform the assigned job.
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions.
• Ability to effectively communicate with patients, physicians, family members and co-workers with a customer service focus.
• Advanced knowledge of the cycle of a patient guarantor account, including hospital and physician charges.
• Knowledge of hospital and PO billing, collections, reimbursement, contractual agreements and the appeals process.
• Advanced knowledge of state collection laws and FDCPA.
• Excellent communication and negotiation skills and ability to work independently and with others.
• Sharp analytical abilities to recognize patient circumstances and resolution options.
• Proficient computer skills and ability to learn multiple software programs.
• Knowledge of medical terminology and applicability.
• Ability to multi-task and adapt to department needs.

Responsibilities

• Promotes a positive work environment and supports a collaborative team.
• Initiates patient contact via phone, letters, and skip tracing as per guidelines.
• May contact outside providers to resolve accounts.

Skills

Communication skills

English proficiency

Customer service

Analytical skills

Billing software

HIPAA compliance

Multi-tasking

Negotiation

Education

High School diploma or equivalent

Tools

Billing software

Job description

At Houston Methodist, the Patient Account Resolution Specialist position is responsible for the prompt resolution of troubled accounts that require special handling in an exception based environment (e.g., uninsured and underinsured patients, VIP accounts, coordination of benefit issues, etc.). This position reviews the full revenue cycle elements (front end and back end) for patient accounts to determine where the account became troubled and utilizes critical thinking to discern resolution opportunities on an individual basis to create patient centric solutions. The Patient Account Resolution Specialist interacts with customers including patients, physicians, hospital and Physician Organization (PO) staff and management, outside providers, and other system entity staff as it relates to the account resolution process. Other duties include assisting management with auditing/quality review to ensure accurate and appropriate billing and account resolution.

FLSA STATUS

Non-exempt

QUALIFICATIONS

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

EXPERIENCE

• Five years of experience in patient billing/collections or insurance, preferably in hospital revenue cycle

SKILLS AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
• Advanced knowledge of the cycle of a patient guarantor account, which will include hospital and physician charges
• Knowledge of hospital and PO billing, collections, reimbursement, contractual agreements and the appeals process, and hospital charity programs
• Advanced knowledge of state collection laws and Fair Debt Collection Practices Act
• Excellent communication and negotiation skills, as well as an ability to work independently and interdependently with other business office staff
• Sharp analytical abilities in order to recognize individual patient circumstances and options for resolution
• Proficient computer skills and ability to learn and navigate multiple software programs
• Knowledge of professional and hospital system billing software related to cash posting functions
• Ability to remain calm in stressful situations with patience and understanding
• Knowledge of medical terminology and applicability
• Ability to multi-task and flexibility to meet the requirements of the department and the organization
• Bilingual skills required if working in international patient account setting

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

• Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal department and organizational results.
• Initiates patient contact through phone calls, letters and using skip tracing techniques defined in department guidelines. May initiate contact with outside providers.

SERVICE ESSENTIAL FUNCTIONS

• Leverages knowledge of external vendor or providers workflow processes and information systems that promote the patient experience to resolve patient concerns more efficiently.
• Reviews the full revenue cycle elements (front end and back end) for patient accounts to determine where the account became troubled. Identifies and offers patient centric opportunities for account resolution based on individual patient portfolio.
• Applies critical thought in order to respond to individual and unique patient account inquiries as a means to satisfy business and customer needs.
• Delivers a top-tier experience to patients, guarantors, patient representatives, as well as internal stakeholders and other providers as applicable. Utilizes clear, concise, and professional communication skills both verbally and written. Exhibits professionalism and trustworthiness.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Utilizes sound judgment and analytical skills to bring the account for resolution, analyzing the data elements (clinical and financial) within the electronic health record to determine the current state of the account.
• Provides clear and concise documentation of every action taken on an account in the system account history notes. Provides balance breakdown to document the status for next necessary account action.
• Meets or exceeds stated Performance Indicator Expectations (e.g., productivity, quality review, aged accounts receivables, account resolution expectations).
• Consistently takes the necessary steps to ensure that protected health information remains private and confidential, according to established Health Insurance Portability and Accountability Act (HIPAA) guidelines. Participates in compliance discussions as required by the organization.

FINANCE ESSENTIAL FUNCTIONS

• Resolves patient accounts by securing payment, insurance coverage (if any), or third-party coverage and confirms accuracy of patient account balance or patient refund amount. Ensures maximization of collection dollars from insurance companies or outside providers in accordance with the respective contract and/or Houston Methodist financial arrangement. Establishes payment arrangements or payment refund in accordance with guidelines set by management.
• Analyzes accounts for errors, adjustments and credits, issuing corrected entries when necessary. Updates account information accordingly. Follows levels of authority for posting adjustments, refunds, and contractual allowances.
• Uses resources effectively and efficiently. Organizes time effectively, minimizing incidental overtime, and sets priorities. Utilizes time between heavy workloads efficiently and helps other team members.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Stays current on collection procedures of various payors and industry trends. Actively engages in personal assessment and expands learning beyond baseline competencies with a focus on continual development (i.e., participates in training opportunities, focal point review activity, etc.). Applies new learning.
• Generates and communicates new ideas and suggestions that will improve quality or service. Demonstrates adaptability and flexibility in the face of changing demands.

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform: No
• Scrubs: No
• Business professional: Yes
• Other (department approved): Yes

ON-CALL*

*Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.*

• On Call* No

TRAVEL**

**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area No

QUALIFICATIONS

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

EXPERIENCE

• Five years of experience in patient billing/collections or insurance, preferably in hospital revenue cycle