Senior account specialist job description

Provides medical collection services for TLRA collection units. Utilizes a strong background as a medical collection specialist to successfully resolve accounts placed with TLRA for collection. This involves performing collection activities related to follow-up and account resolution, and includes communication to patients, clients, reimbursement vendors, and other external entities while adhering to all client, state and federal guidelines. Patient and client satisfaction is essential. Associates in the collection unites are expected to knave knowledge of the overall collection work processes for the both active AR and BD inventory.

Provides effective collection services, ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA's business objectives

Documents and updates patient account information in TLRA's collection software system timely and accurately to include appropriate account status.

Handles inbound patient and/or carrier calls promptly and professionally, providing assistance and resolution to account inquiries, issues and request.

Uses collection tools effectively to ensure quality recovery services and meet or exceed established goals and work standards.

Performs research and analysis of account issues and strives to resolve problems timely and accurately.
Ensure daily productivity standards are met. Promotes positive patient relations by communicating in a manner that demonstrates respect for the human dignity of patients and/or their families. Performs other special projects as required when assigned.
Requirements:
Must have minimum of 3 years' experience in a Customer Service call enter environment with a focus on healthcare billing/collections or collection agency environment or 3 years' experience working in a client service or marketing capacity, preferably in a healthcare or collection agency environment.
General hospital A/R accounts knowledge is required. PC skills in a Windows environment are required. Solid knowledge and utilization of desktop applications to include Word and Excel are essential. College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
Work Type:
Full Time

Senior Patient Accounts Specialist - (220002WP) Description Department Profile

Tampa General Hospital's Revenue Cycle department delivers comprehensive administrative and clinical services and comprises of four departments - Patient Accounts, Health Information Management, Patient Access, and CDI/Coding. The Patient Accounts Department is a segment of the revenue cycle, responsible for the billing of hospital and professional claims to insurance carriers. The Health Information Management department at Tampa General Hospital is the guard of the electronic health record, collaborating with contributors and customers of health information that include the Medical Staff, Clinical Operations, Information Technology and Finance. While the physicians, nurse and health care team are taking care of patients and loved ones, Health Information Management professionals are the ones taking care of patients' health information- ensuring it is captured, complete, accurate, protected and made available when needed. Patient Access provides scheduling services to all TGMG locations, radiology locations and other ancillary services. Financial clearance teams ensure scheduled services are authorized for all service lines. Patient access teams are positioned throughout Tampa General Hospital and in the TGH Emergency Department, TGH Brandon Healthplex, and Rehabilitation locations. The call center is located at the WFLA News Station in downtown Tampa.

Job Summary

Under the direction of the Director, Patient Accounts, performs functions involved in the billing and collection of hospital receivables, customer service duties, the processing and reconciliation of various charge-entry, edit and error reports. Has a diverse knowledge of Patient Accounts follow up techniques and is familiar with a wide variety of payers, such as Managed Care, Self Pay, and Auto. Is consistent, dependable and accurate in carrying out responsibilities to a successful conclusion. Clearly understands purpose, objectives practices and procedures of the department. Performs other tasks that may be assigned by the Manager. Responsible for performing job duties in accordance with mission, vision and values of Tampa General Healthcare.
Qualifications

High school graduate or GED

Minimum of three (3) years of Hospital, Physician or Insurance Payer experience in billing and collecting Medicare/Medicaid

Working knowledge of Federal, State and County guidelines as it relates to billing; and knowledge of electronic billing systems

Primary Location: TampaWork Locations: TGH Corporate Center 606 w. Kennedy Blvd. Tampa 33606Job: Patient Financial ServicesOrganization: TGH - HospitalSchedule: Full-time Scheduled Days: Monday, Tuesday, Wednesday, Thursday, FridayShift: Day JobJob Posting: Sep 19, 2022, 9:54:22 PM

Who We Are
Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

Job Summary
The Provider Account Specialist Senior is responsible for providing accurate and thorough interpretation of benefits, payment policies, claims processes, eligibility and enrollment policies for all product lines (which includes Commercial, Public Plans and Senior Products). Their primary function is providing direct support to the Provider Services Teams, providers, employers, and partner departments. The Provider Account Specialist Senior independently provides education and support regarding operational aspects of all Tufts Health Plan products as deemed appropriate. This includes, but is not limited to, contacting providers regarding THP policy/procedures, disseminating information, identifying and resolving complex claim issues, handling escalated issues, and planning meetings based on employer or provider needs. The Provider Account Specialist Senior, with the assistance of their team is responsible for collecting feedback from providers on the impact of plan operations, policies and procedures and communicating this information to the Servicing Management Team and/or presenting at the Committee level for resolution.

Key Responsibilities/Duties - what you will be doing
Function as the primary liaison for the Tufts Health Plan provider network by educating providers and their office staff on all Plan products, policies, and procedures. Address day-to-day inquiries from internal departments (including but not limited to Sales & Service Department, Network Contracting, Allied Health Services, Member & Provider Services and Senior Management) and providers. Perform outbound call assistance to providers, providing excellent customer service, thorough explanation of issues and resolution as well as accurate and complete documentation of complex issues, on behalf of internal department customers.Act as the primary resource to internal and external customers by obtaining appropriate background information to assist and oversee the troubleshooting and resolution of all inquiries. Requires performing and/or coordinating of related research activities and involving other departments as needed in order to effectively address issues presented. This may include, but is not limited to, benefit, enrollment and eligibility issues, ongoing claims and reimbursement issues, post-settlement issues and trends, clarification of plan policy and procedure, education of members, providers or employers, administrative complaints, etc. Proactively communicate with providers and their office through oral and written communications to promote an understanding of benefit interpretation, claims & reimbursement issues, referral management, general billing issues, benefit interpretation, and overviews of internal departments as needed. Identify trends and issues that are primarily reported by the Provider Services call center vendor, and report and escalate as needed.Participate in various company/departmental initiatives, projects, or committees as assigned by management. This may include process improvement initiatives and participating on cross-functional teams. Flexibility to expand roles and responsibilities as deemed necessary.Manage and track escalated issues as well as assist in resolution.Act as Senior primary point of contact for assigned and/or escalated provider groups to assist with operational issues, billing, and issue resolution.

Qualifications - what you need to perform the job
A minimum of two years of experience in a managed care/health industry environment required. A bachelor's degree is preferred. In addition, a minimum of 12 months Member or Provider Services Call Center experience preferred. Excellent verbal and written communication skills, generally acquired through college or other advanced education, are required. Knowledge of medical terminology and medical coding is preferred.

Skill requirements (include complexity of position and specify whether the job regularly requires independent judgment and discretion):
Solid knowledge of THP products & claims processes, proficiency with the MS Windows, proficient keyboard skills and excellent communication skills. Requires strong organizational skills as well as the ability to research and respond to a high volume of issues via the phone, e-mail, or in writing in a consistent and professional manner. Basic math, grammar, and spelling skills are required.

Extensive technical aptitude to understand complex systems and programming logic Must be able to work collaboratively and cooperatively as a team member, fostering an atmosphere of trust and respect Ability to plan outcomes for a work group session and manage group dynamics to effectively reach a positive meeting outcome.Must possess strong analytic skills, be meticulous with detail and ability to track, trend and document using a variety of different applications/tools.Must be able to build effective working relationships internally as well as externally Ability to be flexible and a proponent of change. Ability to envision the impact of change and ways to do business.Must possess initiative, balanced judgment, objectivity and the ability to plan and prioritize one's own work to assume maximum efficiency. Demonstrated ability to synthesize and process complex information and deliver the information, both verbally and written, in a clear, concise and articulate manner. Requires strong verbal and written skills to effectively communicate at both detail and summary levels to THP management Requires excellent interpersonal skills in order to communicate and work with the staff of all skill and experience levels Ability to assume a leadership role within workgroups and projects Must be highly organized and self-directed, with ability to work independently and in team settings on projects of diverse nature. This position requires a high level of analytical, initiative and judgment combined with the ability to perform in an extremely complex and fast paced environment under pressure.This individual must have the ability to perform under limited supervision in which the Team Lead makes assignments by defining objectives, priorities and deadlines and assists with unusual situations that do not have clear objectives and the employee plans and carries out successive steps. Must demonstrate personal resiliency in time of changing direction and consistently perform routine daily deliverables independently. Must be able to identify and recommend opportunities for system or process improvement.

Interpersonal skills (include personal interaction):
Must be able to work cooperatively as part of a team. Requires excellent interpersonal skills and an ability to provide outstanding customer service in order to promote a positive company image. Must be able to effectively communicate with all internal departments and external business partners verbally and in writing. Must be flexible and capable of multi-tasking. Prioritization of work may need to change as a result of the need of the internal or external customer.

Confidential data:
All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Will be exposed to and required to deal with highly confidential and sensitive material. Must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

Working Conditions or Additional requirements (include special requirements, e.g., lifting, travel, overtime):
Fast paced office environment handling multiple demands. Must be able to exercise appropriate judgment when necessary.

Commitment to Diversity, Equity & Inclusion
Point32Health is committed to making diversity, equity, and inclusion part of everything we do-from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

COVID Policy
Please note: As of January 18, 2022, all employees - including remote employees - must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.