Housing management representative job description

The purpose of this position is to ensure clean claim submission and follow up on unpaid accounts. This person is responsible for correcting issues, resubmitting claims, filing necessary appeals, and obtaining addition needed information to assure timely and correct payments.

Responsible for managing the billing, collection and follow up of insurance receivables for all government or 3rd party payers using various billing systems, websites, reports and other tools as required.
Follows-up on errors and denials for eligibility, coding, authorization, medical necessity, etc. Regular contact with 3rd party payers and patients to acquire information as needed. Analyze, investigate and resolve claim and account issues to ensure timely cash collection or write off. Manages account workload as assigned efficiently and effectively. Ensures clean claim submission to avoid account rework. Ensures timely account resolution to avoid write offs. Resolves coding or billing problems based on correspondence, EOBs and rejections; correcting errors in a timely manner. Identifies problem accounts and escalate as appropriate. Works with patients and guarantors to secure payment on outstanding account balances. Prioritizes follow up activity to ensure maximum collections through a high balance review and meeting timely filing requirements. Understands various payer requirements and processes to ensure appropriate follow-up. Utilizes a professional/aggressive approach to account management. Meets department productivity and quality expectations. Remain result-oriented in approach to problem solving; using insight to achieve a qualitative approach to account follow-up. Adheres to various policies/procedures regarding billing, follow up, adjustment and escalation protocols. Resolves denials effectively by correcting claims, submitting reconsiderations and appeals based on payer requirements.


Minimum Qualifications:


Education

High school graduate or GED equivalent is required

Experience

One year previous medical billing

Certifications, Licenses, and Registrations

None

Skills and Abilities

Knowledge of various reimbursement/-billing formularies (ICD10, CPT4, HCPCS and DRG) is required Knowledge of claims submission processes for all major carriers and intermediaries required

Responsible for obtaining and verifying demographic and financial information for all inpatients and outpatients prior to or during the registration process. Patient Registration Representative II's will minimize the financial risk of providing services by assessing the patient's financial status, verifying and entering accurate patient information into the HBOC (Clinstar) system, obtaining signatures on all required hospital and regulatory forms and obtaining applicable patient payments prior to or at the time services are provided. Excellent customer service skills are utilized in all dealings with patients, family members, physician offices, third party payers and co-workers. Financial/insurance information is communicated to case management and financial counseling staff when appropriate. Completes all managed care notification requirements. Maintains patient confidentiality and adheres to the hospital's privacy and security policies at all times. May be required to enter lab and radiology orders when necessary.
**Minimum Knowledge, Skills, and Abilities Required:**

+ High school graduate or GED equivalent.

+ Ability to communicate clearly and effectively in both verbal and written form. Fluency in both English and Spanish preferred.

+ One year experience in a hospital and/or other health care setting, preferably in bed management or patient placement, registration, billing or insurance requirements. Familiarity with third party/insurance payers and medical terminology preferred. Related college level courses may be considered in lieu of work experience.

Holy Cross Health is an Equal Employment Opportunity (EEO) employer.

Qualified applicants are considered for employment without regard to Minority/Females/disabled/Veteran (M/F/D/V) status.

**Our Commitment to Diversity and Inclusion**

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

• High school diploma or GED required.
• Must have previous experience in health care setting.
• Detail-oriented with strong communication and organizational skills.
• Familiarity with referral management plans and computer skills preferred.
• Team oriented, with a strong commitment to helping others.
• Bilingual in Spanish preferred.
• Must have familiarity with referral management plans and computer skills.
• Ability to complete 50-60 referrals per week depending of complexity.
• Able to commute between sites Brighton/Waltham as needed.
• Able to answer high call volumes and attention to details.

WHO WE ARE & WHAT WE DO

Charles River Community Health’s mission is to improve the health and well-being of the communities of Allston, Brighton, Waltham and surrounding areas by providing quality, compassionate, coordinated care that is patient-centered, family friendly, and community focused. CRCH is a comprehensive practice providing medical, pharmacy, dental, behavioral health, optical, and vision services to diverse underserved local communities. We are committed to providing patients with timely access to the right care, at the right place and at the right time, collaborating with other organizations to connect patients with a comprehensive range of services and provide continuity of care, and creating new community partnerships to meet the changing needs of patients and the community. We value caring for everyone with dignity, respect, and compassion, reducing cultural, financial and other barriers to care, and eliminating health care disparities for our patients. We also advocate for the needs of our patients, the community, and public health causes.

OUR PROMISE

If you are passionate about providing access to quality and compassionate care to the underserved, you will find your career rewarding and impactful. As Referral Management Representative (RMR) , you will be part of a dynamic team and will find a partner in your career path goals and trajectory!

OUR BENEFITS & PERKS

Medical & Dental Insurance

Short & Long-term Disability Insurance

Generous Paid Time Off

Flexible Spending Account

Employee Assistance Program

Tickets at Work

Health Reimbursement Arrangement

Travel Reimbursement

Professional Development Opportunities

Solid track record of developing and promoting employees internally!

Charles River Community Health is strongly committed to diversity and a workplace environment that respects, appreciates and values employee differences and similarities. By providing and supporting a work culture that fosters and builds upon diversity and its strengths, CRCH will better serve our local communities and continue to provide quality patient care and services. CRCH is an employment at-will organization and an equal opportunity employer committed to maintaining a work and learning environment free from discrimination on the basis of sex, race, color, religion, national origin, pregnancy, gender identity, sexual orientation, marital/civil union status, ancestry, place of birth, age, citizenship status, veteran status, political affiliation, genetic information or disability, as defined and required by state and federal laws. Additionally, CRCH prohibits retaliation against an applicant or employee because he or she has engaged in protected activity under the statutes prohibiting discrimination in the workplace.