Reconciliation Representative

Hackensack Meridian Health; Hackensack (NJ); On-site; USD 28,000 - 39,000; Full time

Benefits offered by this job

Health, dental & vision benefits

Paid leave

Tuition reimbursement

Retirement benefits

Job summary

Hackensack Meridian Health is seeking a Reconciliation Representative in New Jersey to adjudicate accounts with payment and denial postings across the HMH network. You will verify that payments align with expected reimbursements and identify issues for management regarding variances in Accounts Receivable after posting.

You will review billing practices, reconcile data, process denials, and communicate discrepancies to drive timely revenue recognition and maintain cash flow.

Qualifications

• Associate's degree or equivalent experience in accounting/finance/billing.
• Minimum 2+ years in patient accounting or revenue cycle operations.
• Knowledge of Managed Care, Medicare and Medicaid.
• Proficiency with EPIC, Google Suite and MS Office applications.
• Strong analytical and communication skills.

Responsibilities

• Reviews billing practices to ensure invoice/claims accuracy and proper revenue recognition.
• Acts as liaison with other departments to adjust or reconcile financial data.
• Researches customer complaints and makes necessary adjustments and/or recommendations to resolve issues.
• Analyzes and records variances in Epic at account adjudication and documents activity.
• Performs account analysis to determine if balance is due from payer or patient; manages timely adjudication.
• Processes denials and correspondence, routes denials for appeals to maximize revenue and cash flow.
• Evaluates refunds and ensures timely processing to avoid patient complaints.
• Reconciles Managed Care, Medicare and other Government payments/denials to EOBs and posts allowances.
• Communicates issues to management to prevent future occurrences; provides data on discrepancies.
• Escalates accounts needing coding or billing review and responds to inquiries.

Skills

Excellent written and verbal

Good analytical skills

Excellent interpersonal skills

Creative thinking

Education

Associate's degree in Accounting/Finance/Billing/Coding or related field

Tools

EPIC

Google Suite

Microsoft Office

Job description

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Reconciliation Representative performs adjudication of the accounts that have payment and/or denial postings across the Hackensack Meridian Health (HMH) network. This process verifies that the payment received for the account is equal to the expected reimbursement and to identify issues for management regarding significant variances on Accounts Receivable after payment is posted. Timely adjudication of accounts prevents Accounts Receivable from aging and, therefore, achieves the targeted goal on a monthly basis.

Responsibilties

A day in the life of a Reconciliation Representative at Hackensack Meridian Health includes:

• Reviews organizational billing practices to ensure invoice/claims accuracy and proper revenue recognition.
• Acts as a liaison with other departments to adjust or reconcile financial data.
• Researches customer complaints and makes necessary adjustments and/or recommendations to resolve issues.
• Analyzes and records variances in Epic at time of account adjudication. Accurately and thoroughly documents activity performed.
• Performs account analysis to ascertain the balance on an open account to determine if balance is due from payer or patient. Maintains inventory, adjudicates timely and resolves high priority issues to prevent accounts from aging unnecessarily.
• Processes all denials and correspondence in a timely manner; analyzes, categorizes and routes all denials to initiate an appeal process which ensures maximizes revenue and cash flow.
• Evaluates credit balance for patient and health plan refunds and assesses patient accounts to calculate accuracy of refund. Ensures timely processing of patient refund to avoid patient complaints.
• Researches and verifies validity of daily credit card chargeback.
• Reconciles Managed Care, Medicare and other Governmental payments and/or denials to the explanation of benefits. Performs comparison of EOB to the negotiated rates for accuracy of reimbursement. Posts appropriate allowance due to system calculation discrepancies.
• Communicates issues and causes of manual allowance to management relating to contract management, payer or high volume issues to prevent future occurrence.
• Provides statistical data on payment discrepancies, which enables management to accurately monitor Accounts Receivable activity on an on-going basis. Data provided will be forwarded to Information Technology for contract management correction and/or updates may also result in payer escalation.
• Escalates accounts that need coding or billing review.
• Responds to patient or payer phone inquiries regarding refund process and payment related inquiries.
• Receives and researches Customer Service, front-end and other departments inquiries as needed to resolve specific account issues.
• Performs analytical support to Patient Accounting and Finance staff as it relates to monthly cash receipt and posting.
• Contacts payers, patients, other departments and/or agencies to secure the appropriate information to properly adjudicate the account.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required

• Associate's degree with a concentration in Accounting, Finance, Billing, Coding, another related field, or equivalent relevant experience.
• Minimum of 2+ years experience in patient accounting/revenue cycle operations or relevant experience/training.
• Demonstrated knowledge of Managed Care Contracts, Medicare, and Medicaid.
• Possesses beginning to working knowledge of subject matter.
• Proficiency in Google Suite/Microsoft Office applications, SMS, EPIC and/or other hospital billing systems.
• Good analytical skills.
• Excellent written and verbal communication skills
• Excellent interpersonal skills.
• A certain degree of creativity and latitude is required.

Education, Knowledge, Skills And Abilities Preferred

• Experience in Healthcare.
• Good basic accounting skills.
• Fast and accurate data entry skills.

Licenses And Certifications Required

• Must successfully pass completion of EPIC assessment within 30 days after Network access granted

HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package.

Job Duties

The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on a number of non-discriminatory factors, including but not limited to:

• Labor Market Data: Compensation is benchmarked against market data to ensure competitiveness.
• Experience: Years of relevant work experience.
• Education and Certifications: Level of education attained, including specialized certifications, credentials, completed apprenticeship programs or advanced training.
• Skills: Demonstrated proficiency in relevant skills and competencies.
• Geographic Location: Cost of living and market rates for the specific location.
• Internal Equity: Compensation is determined in a manner consistent with compensation ranges for similar roles within the organization.
• Budget and Grant Funding: Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered.

Some jobs may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate. Certain positions may also be eligible for shift differentials for work performed on evening, night, or weekend shifts.

In addition to our compensation for full-time and part-time (20+ hours/week) job positions, HMH offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits.

Minimum rate of $24.34 Hourly