Hybrid Account Representative at SPINE TEAM TEXAS MANAGEMENT COMPANY

Description

The Spine Team Texas Insurance Account Representative is responsible for resolving denied claims, researching and resolving patient accounts, and resolving both insurance and patient credits, including refunds, as well as maintaining working correspondence.  As an AR Specialist, you will play a crucial role in optimizing revenue flow by effectively managing outstanding accounts receivable and ensuring timely reimbursement.  The Account Representative Specialist reports directly to the Revenue Cycle Manager.

Spine Team Texas Attributes

In order for Spine Team Texas to meet the goals expressed through the company mission statement, it is imperative that all employees possess the following attributes:

1. Knowledge – The blending of job-related education, skills and experience.
2. Quantity – Level of satisfactory output generated in position per unit time.
3. Accuracy – Absence of errors.
4. Judgment – Capacity to make reasonable decisions.
5. Innovation – Imagination and creativity used to better position.
6. Appearance & Habits – Personal habits, grooming, uniform / clothing.
7. Orderliness – Organization of the individual’s work and work area.
8. Courtesy – Respect for feelings of others.  Politeness on the job.
9. Cooperation – Willingness to help others accomplish their objectives.
10. Initiative – Voluntarily starting projects.  Attempting non-routine jobs and tasks.
11. Reliability – Dependability and trustworthiness.
12. Perseverance – Steadfast pursuit of job objectives when faced with unexpected obstacles.
13. Stability – Even temperament. Acceptance of unavoidable tension and pressure.
14. Alertness – Ability to quickly understand new information and situations.
15. Professionalism – Professional actions, communications and attitude.
16. Team work – Ability to work in a team for the betterment of staff, patients, and the Company.
17. Observance – Observance of Company policies and procedures.
18. Attendance – Consistent adherence to work schedule.

Job Responsibilities:

1. Analyze and review outstanding claims, focusing on those with no response or denials.  Identify and rectify errors, discrepancies, and missing information to resubmit claims promptly and accurately.
2. Utilize knowledge of payor policies, medical coding guidelines, and billing regulations to appeal denials and secure correct reimbursement.
3. Manage all incoming correspondence related to accounts receivable.  Take necessary actions based on correspondence received, such as claim corrections, appeals, adjustments, or post-claim review medical records requests.
4. Conduct thorough follow-ups on aging accounts receivable, prioritizing those with no response or denied claims.  Utilize various communication channels to contact payers, patients, and other relevant parties to resolve outstanding balances and secure payment.
5. Submit written appeals to carriers when applicable and ensure timely follow-up regarding status.
6. Stay up to date with changes in payor policies and billing requirements.  Ensure compliance with HIPAA, CMS, and other regulatory standards governing healthcare billing and reimbursement.

Customer Service

All Spine Team Texas employees are required to maintain the highest level of customer service at all times.  Employees must always speak in a kind, courteous and professional manner when dealing with a patient/customer or co-worker.  Employees are required to fulfill the Spine Team Texas mission of “Offering an Unparalleled Patient Experience!”  All employees must exhibit a spirit of cooperation and positive attitude.  Professionalism is to be maintained at all times.

Team Concept:

Spine Team Texas was founded on a team concept approach.  To build and enhance the team, each employee must contribute positive interaction, promote value and be a “team-player” not only for their unit or department, but for Spine Team Texas as a whole.

Physical Requirements & Work Environment

Must be able to sit for long periods of time in a well-lit, air-conditioned office environment.  Must have ability to lift a minimum of 5 pounds.  Must be able to work under pressure.  Tasks involve no exposure to blood or other potentially infectious materials.

Qualifications

Educational Requirements & Position Qualifications:

1. High School diploma or equivalent is required.
2. AAPC Certified Medical Coder a plus.
3. Minimum of 3 years’ medical collections experience required, specifically in professional and institutional billing.
4. Proficiency in medical billing software, Athena Practice, and electronic health record (EHR) systems.
5. Strong knowledge of healthcare billing processes, medical terminology, CPT, ICD-10 coding, and billing regulations.
6. Excellent analytical skills with the ability to identify patterns, trends, and discrepancies in claims.
7. Ability to prioritize tasks, meet deadlines, and work efficiently in a fast-paced environment.