Revenue Cycle Representative II

Health Partners Plans; Pennsylvania; On-site; USD 52,000 - 68,000; Full time

Job summary

Albert Einstein Medical Center is seeking a Payment Research Representative to ensure accurate handling and reconciliation of payments received across the Jefferson Revenue Cycle Enterprise. You will work with Payment Representatives, Accounting, and Finance to investigate issues affecting cash processing and reconciliation.

The role requires strong proficiency in MS Excel/Access, Windows 10, and Epic knowledge, with a focus on accurate posting and timely resolution of discrepancies.

Qualifications

• High School Diploma or GED is required.
• Proficient in Windows 10 and Microsoft Office; strong Excel and Access skills.
• Ability to work independently and as part of a team with minimal supervision.
• Proficient in web tools and technology.
• Knowledge of accounting ledgers and balance sheets.
• Strong organizational and interpersonal skills; excellent verbal and written communication.

Responsibilities

• Interact with staff and follow value-based conduct.
• Identify and resolve payment issues through research and investigation; verify payments per explanations of benefits.
• Contact third party payors or view payor portals for information.
• Use payor portals (e.g., Navinet) for claims determination and eligibility.
• Apply payments and adjustments to patient accounts per third party rules; ensure AR accuracy.
• Review postings of payments/denials from EOBs via images or remittance work queues.
• Investigate over-posted or undistributed credits and ensure proper linkage of cash to batches.
• Notify supervisor of potential system or reimbursement issues for action.
• Adhere to workflows and maintain quality assurance standards.

Skills

MS Excel

MS Access

Communication skills

Team collaboration

Independent worker

Web tools proficiency

Accounting knowledge

Organizational skills

Verbal and written communication

Education

High School Diploma/GED

Bachelor's Degree in Accounting/Finance/Business

Tools

Windows 10

Microsoft Office

Epic

Job description

Number of Positions In Requisition 1

Job Description

The Payment Research Representative is responsible for proper handling and reconciliation of payments received throughout the Jefferson Revenue Cycle Enterprise. Working closely with Payment Representatives, Accounting and Finance, the Payment Research Rep will investigate and resolve issues impacting cash processing and reconciliation.

Job Duties

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Identify and resolve payment issues through research and investigation. Review explanation of benefits to confirm payments were applied appropriately.
• Contact third party payors or view payor portals to obtain additional information as necessary.
• Utilize online payor portals, such as Navinet, for claims determination, eligibility, offset requests and appeals.
• Applies payment and adjustments to patient accounts per third party regulations, providing accurate accounts receivable and balance billing while meeting the department's established productivity benchmarks.
• Interprets and validates transaction postings of payments and denials received from third party explanation of benefits either in the form of batched images or via electronic remittance posting work queues.
• Research over-posted or undistributed credit balances via credit work queues.
• Confirm that cash records are properly linked to associated payment batches prior to posting. Ensure that batches are posted, reconciled, closed and processed timely and accurately.
• Communicate possible system and reimbursement issues to the supervisor who will facilitate a review and analysis of the potential impact and confirm best course of action.
• Adhere to workflows and ensure quality assurance standards are maintained at all times.

Minimum Qualifications

• High School Diploma/GED
• Proficient in Windows 10 and Microsoft Office. Strong MS Excel and Access skills required.
• Ability to work independently and as part of a team with minimal supervision
• Proficient in web tools and technology
• Knowledge of accounting ledgers and balance sheets
• Strong organizational and interpersonal skills; excellent verbal and written communication skills

Preferred Qualifications

• Bachelor's Degree Accounting, Finance or Business
• Knowledge of Epic
• EDI related experience
• Medical billing and or banking experience preferred

Physical Demands

• Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Albert Einstein Medical Center Primary Location Address 60 Township Line Road, Elkins Park, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health , nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.