Account Representative – PFS AR Management

 
Position: Account Representative – PFS AR Management

Location: US-TX-Houston

Talent Area: Administrative Support

Shift: 8a - 5p

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.   Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, a second community hospital opening in 2017. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.   To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Summary:

We are searching for an Account Representative – someone who works well in a fast-paced hospital setting. In this position, you will provide collections follow-up on all assigned Accounts Receivable accounts to ensure continuity of cash flow and the collection of every collectible dollar with efficient account resolution. You will also work closely with Admissions, Billing, Medical Records, Care Management, and Contracting in order to retrieve information supporting appeals and communicating denial trends.

 

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Responsibilities :

  • Initiates calls or online web contact to payors or guarantors to verify receipt of claims/statements and collect on outstanding accounts receivables as specified by current collection policies and procedures
  • Documents follow-up activities, conversations with payors/guarantors, information obtained via the web contact, and any correspondence in the account notes
  • Ensures payments received by third party payors are correct and the correct contractual discounts/allowances have been applied according to the contract matrix or government reimbursement rates. Ensures that all accounts associated with that guarantor and payor relationship are resolved
  • Analyzes and assesses accounts for outstanding balances and makes prudent decisions on appropriate actions needed to resolve the balance
  • Identifies and reports inaccurate reimbursement and contractual trends to Sr. Reps, Team Lead, or Manager
  • Initiates contact with third party payors to collect on outstanding receivables that have been underpaid or denied for payment
  • Maintains assigned accounts receivable at or below specified departmental targets and goals
  • Follows established departmental workflows to ensure that all accounts are being worked in a timely manner


Qualifications:

  • A high school diploma
  • A minimum of two years in collections (preferably in a hospital setting)
  • Knowledge of government, commercial and managed care reimbursement methodologies and understanding of all federal, state, and local legal aspects of collection regulations
  • The knowledge of how managed care plans work and the requirements for insurance coverage and benefits
  • Strong math aptitude in order to be able to verify the appropriate reimbursement based upon the contract terms, benefits and/or government regulations

 



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