Account Representative - Museum District

At Houston Methodist, the Account Representative position is responsible for resolving all outstanding third party primary and secondary insurance claims for professional services. This position performs collections activities on simple and complex denials and on outstanding insurance balances in the professional fee environment. This role is also responsible for providing information regarding denial trends for future prevention.

Non-exempt

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

• Three years of physician billing experience, preferably in a multi-specialty physician practice

• 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
• In depth knowledge of Current Procedural Terminology, 4th Edition (CPT-4), International Classification of Diseases Ninth Revision (ICD-9), International Classification of Diseases Tenth Revision (ICD-10), and Healthcare Common procedure Coding System (HCPCS) coding
• In depth knowledge of third party payor reimbursement policies and procedures
• Understands payor environment such as managed care, independent physician associations (IPAs), and third-party administrators (TPAs)
• Extensive knowledge of billing, collections, reimbursement, contractual agreements and the appeals process
• Understanding of revenue cycle fundamentals
• Ability to follow-through and handle multiple tasks simultaneously
• Excellent communication and negotiation skills, as well as an ability to work independently and interdependently with other business office staff
• Good judgment in handling of accounts and ability to apply a professional approach in dealing with patients and insurance companies
• Sharp analytical abilities in order to resolve patient accounts in a timely and correct manner
• Proficient computer skills and ability to learn and navigate multiple software programs
• Ability to remain calm in stressful situations with patience and understanding

• Collaborates with management to reduce aging of accounts by providing verbal and written communication.
• Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further delay in payments. Collaborates with internal CBO departments and Account Managers to communicate and prevent denials. Provides suggestions for resolution.
• Assists with knowledge sharing, payor and department cross training, and provides support to other team members as advised by the manager and/or supervisor.

• Completes special projects to improve team performance, as assigned.
• Demonstrates expertise of all payors, including Medicare, Medicaid and commercial payors, and applicable department’s revenue cycle operations.
• Ensures protection of private health and personal information. Adheres to all Health Insurance Portability and Accountability Act (HIPAA) and Payment Card Industry (PCI) compliance regulations.

• Reviews third party payor work queues to locate and resolve accounts. Resolves denials as they appear. Documents clear, concise and…