Account Rep Ld Follow-up

Supports Hospital Billing Supervisor and provides leadership and direction to the Account Resolution Representatives.

Is the primary resource for training of new team members and continued training of current staff.

Lead will assist in the coordination and implementation of new procedures and protocols within the department.

They will be a resource for escalated insurance issues.

The lead may also be required to perform Account Resolution Rep duties in addition to the Lead essential functions.

This role will participate in the evaluation and measurement of staff quality and productivity.

This role will review staff work such that it facilitates cash collections and ensures that claims are paid according to contract or at the accepted reimbursement dollar amount.

Essential Functions

• Trains, orients and provides resource support for the assigned follow-up work group, including information related to departmental operations and computerized systems.

Responsible for set-up and upgrades of computerized systems to include entry, testing and training of staff.

• On a daily basis, reviews the denial, follow-up, credit, and variance work‑queue claims volumes to assess follow-up needs and identify shortfalls.
• Monitors and reviews Epic A/R reports and Workqueues to ensure that claims are followed up on within each payer’s timely filing guidelines/requirements.
• Coordinates the high dollar claim review process to ensure that timely and effective follow up is being performed by staff.
• Conducts staff audits to measure the quality of work being done by staff as well as staff adherence to department standards.

Assists with productivity reporting as needed and along with the Supervisor.

• Maintains issues list for staff meetings to ensure documentation and follow up occurs on identified issues and problems.
• Assists the supervisor with development of department processes and procedures as needed.
• Receives, investigates and responds to problems and/or questions from staff, insurance companies, families and other departments.
• Provides support to assigned follow‑up work group team and assists staff in the resolution of complex accounts.
• Identify and resolve outstanding claim deficiencies resulting from aged billing, denials or under/overpayments using EPICwork queues and reporting tools within the time frame given by management.
• Legacy Essential Functions
• Maintains current knowledge of managed care payer contracts and third‑party payer billing/ reimbursement policies for all lines of business (Government, HMO and Commercial)
• Maintains a thorough understanding of A/R functions, Department policies and procedures, information systems and business relationships.

Education

• High School graduate or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED) Required and
• Associate’s Degree in medical billing, finance or accounting preferred. Preferred and
• Bachelor’s Degree in medical billing, finance or accounting preferred. Preferred

Experience

• 2+ years experience in health care revenue cycle operations including insurance reimbursement procedures and comprehension of insurance EOB’s.

Pediatric experience a plus.

• Preferred and
• Prior Epic experience is strongly preferred. Preferred
• Knowledge, Skills and Abilities
• Excellent verbal and written communication skills. Bilingual a plus.
• Strong analytical skills and ability to perform non-complex arithmetic calculations when determining contractual allowances.
• Ability to work independently with minimal supervision.
• Ability to demonstrate leadership skills.
• Proficient in Microsoft Office applications and technology skills required to perform duties.
• Professional certification in claims processing through HFMA or AHAAM is a plus.
• The ability to multi-task and function effectively in a team environment and maintain effective relationships with coworkers, patients, physicians, management, staff, and other customers.
• Required for All Jobs
• This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that may be requested in the performance of this job.
• Employment is at-will. This document does not create an employment contract, implied or otherwise.

Fully Remote Work Opportunity!

Children’s Wisconsin is an equal opportunity / affirmative action employer.

We are committed to creating a diverse and inclusive environment for all employees.

We treat everyone with dignity, respect, and fairness.

We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.

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