Full-time, 40 Hours/Week

Monday - Friday, 8am-4:30pm

Remote (Applicant must reside in OH or PA)

Summary:

The representative utilizes telephone, email, and letters for verbal and written communication when providing assistance for families and insurances with all concerns and complaints regarding hospital and/or physician services. Documents interactions and transactions; details of inquiries; complaints and comments; and actions taken

Responsibilities:

1. Responsible for the timely and accurate updating and processing of patient registration, and insurance information.
2. Responsible for investigating current insurance eligibility information through web sites established by Third Party Insurance and Governmental Payers to locate accurate information needed for timely claims submission.  
3. When questioned can review patient accounts that are denied by the insurance companies. 
4. Facilitate further investigation of denied claims to determine if denial may have been appropriate.  If denial is inappropriate accounts are returned to applicable team members to appeal with the insurance for reconsideration and ultimate payment.   
5. Identifies denial trends and works with administrators or managers of various Hospital Departments.
6. Responsible to inform leadership of denial trend information and work with them towards a resolution. 
7. Meets with coding representatives to identify and resolve denial trends.
8. Shares information regarding denial trends with Managed Care Department to resolve payment issues at the contract level.
9. Responsible for promoting positive internal and external relationships while providing superior customer service.
10. May performs financial screening of guarantors and assist families with the application process for HCAP/Charity. 
11. Must have an understanding of health benefits and services rendered to identify the root cause/complaint/issue. 
12. Read/interpret and provide guidance to guarantors related to payer EOBs. 
13. May be responsible for the collection of self pay accounts billed for services, including establishing payment arrangements.
14. May be called as hospital representative for legal collection cases and may be required to testify at court hearings.
15. Triage and escalate complaints and patient care issues trending as appropriate.
16. Responsible for special projects that support the Revenue Cycle process.
17. Create and maintain spreadsheets for projects as needed.
18. Other duties as assigned.

Other information:

High school graduate or equivalent required.  One (1) year experience in a physician/hospital billing setting required, three (3) years preferred.  Must have strong interpersonal skills as required to handle sensitive and confidential information. Must have above average communication and organizational skills to communicate verbally, prepare written communications for patients, patient families, physicians, third party payors, collection agencies, attorneys and other staff members.  Prior experience in processing personal and confidential data when updating demographic and medical insurance information.  Is proficient in utilizing third party and governmental web sites to locate accurate information needed for timely submissions of coverage and claim processing.

Must have experience with computerized physician/hospital systems. Ability to process large amounts of data in a timely manner, executes projects, create and maintain spreadsheets. Thorough knowledge of medical terminology and ICD9/10 CPT coding preferred.  Ability to demonstrate professionalism, strong customer service and analytical skills. Highly developed attention to detail with ability to cross train to other functions as necessary.  Numerical aptitude and the ability to exhibit proficient personal computer skills including, but not limited to, Microsoft Word and Excel is required. Must be results oriented and able to work independently to set priorities. Employee has a tremendous responsibility to the people we serve. Individuals who share these values and who are driven to make a difference will be considered for this position Prior EPIC experience a plus.

Full Time

FTE: 1.000000

About Akron Children's

More Than a Job. It’s loving what you do - and why you do it. Akron Children’s Hospital is ranked among the best pediatric hospitals by U.S. News & World Report, but it’s our compassionate approach to treatment that sets us apart. It’s creating special high-fives. Thinking of new ways to spark a smile. Holding hands to offer comfort. And working to get a giggle that brightens a room. The minute you walk into Akron Children’s, you can sense that people here love what they do. From visits with the Doggie Brigade, to the balloons and smiles in the halls, the sights and sounds are all about one thing: the children. We are the largest pediatric healthcare system in Northern Ohio and one of the fastest growing in the country. Akron Children’s has two hospital campuses in Northeast Ohio: one in Akron and the other in Boardman in the Mahoning Valley. With two hospital campuses, regional health centers and more than 50 primary and specialty care locations throughout Ohio, we’re making it easier for today’s busy families - regardless of where they live - to find the high-quality care they need. No matter which of our locations you choose, you’ll see that when you give the most, you get more—...support, rewards and satisfaction. CAREER OPPORTUNITIES: It’s making the most of your days. Our passion is felt every day in the way people care at every level. Whether you are working with children face-to-face, or behind the scenes supporting the care and services we deliver, you impact futures. Visit us and see why it’s more than just a place to work. It’s a family. Apply today at careers.akronchildrens.org.

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