Accounts Receivable Representative
Description Our PASSION – Our MISSION At Sage our purpose is to provide our healthcare finance partners a product that outperforms the industry standards in Revenue Cycle Management. Through our executive healthcare leaders, who have extensive experience in healthcare operations, and our talented team members, Sage has the solutions to our clients’ challenges. We provide services that reflect integrity, quality, technology innovation and value by being agile and dedicated to exceeding expectations. Our Values We are a values driven organization focused on people, processes, and technology. Performance expectations will include our values: Focused attention on customer service Building strong and authentic relationships by consistently demonstrating intent, honesty, integrity, and respect Being accountable to exceptional quality work Think differently and introduce new ideas Be observant to our work, asking why, doing the research for positive solutions to issues Job Focus: This position is responsible for Billing, Re-Billing, Post-payment, and Account Follow-up and/or grievance preparation of assigned Client EMR Accounts Receivable. The responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and other insurance groups. Partners with other team members and health plans to facilitate the appropriate and prompt payment of claims. This individual must demonstrate a commitment to the organization’s strategic plans, short and long-term goals and mission, vision, and values by representing the company in a caring and professional manner. Expectations For Success: Billing: Reviews and/or scrubs final billed initial claims for accuracy and completeness prior to submitting to payer Calculates Tier, Outlier, DRG and/or other Fee Schedule based reimbursement Submits electronic and/or hardcopy claims with any attachments as per the contract timely filing criteria Documents all account activity in the hospital/client system and The Q with clear and concise notes Insurance Follow-up: Within appropriate time frames, contact the health plan by phone or website to determine status of claim Documents all follow-up actions in the hospital/professional account notes and sets up accounts for additional review based on client expectations for follow-up of unresolved accounts Post Payment Review: Research and validates the paid or partially paid claim status is in accordance with the expectations outlined in the client contract agreement Deliberately and thoroughly reviews any denied, dis-allowed, or non-covered claims / charges and determines accuracy based on contract language Resolves any technical issues when warranted with payer Follows client specific procedures to request adjustments and refunds Prepares appeal and necessary documentation for authorization, coding, level of care and/or length of stay denials Follow guidelines for prioritization and timely filing deadlines Primary Focused Work: (this is not an exhaustive list) Following all sorting and filtering guidelines which includes: High Dollar All age groups Special Accounts Works ALL Payers Physical Environment: Prolonged periods of sitting at a desk and working on a computer Must be able to lift 15 pounds at one time Must be able to structure your home office to ensure patient information is secure meeting the regulatory expectations
Requirements
Skills Needed to Be Successful: Maintains compliance with regulations and laws applicable to job Professional level of communication with video, phone, and email Ability to effectively prioritize the work to meet deadlines and expectations Meets the quality and productivity measures as outlined by Quadris Brings positive energy to work Uses critical thinking skills Being present and focused on assigned tasks and eliminates distractions Being a self-starter Ability to work independently and within a team atmosphere Core Talent Essentials: High School diploma or equivalent 2+ years previous experience in healthcare revenue cycle management Ability to work independently and within a team atmosphere Advanced proficiency of CPT and ICD-10, and full-scope revenue cycle management framework Self-motivated and passionate about our mission and values of quality work Must have professional level skills in MS products such as Excel, Word, Power Point Proficient application of business/office standard processes and technical applications