Work where every moment matters.
Every day, over 38,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.
The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.
Position Summary:
Under the direction of Patient Financial Service (PFS), Accounts Receivable (AR) or Claims Supervisor, assure timely and accurate submission of claims on UB04 or HCFA1500 (bills), monitor responses from clearinghouse, review Electronic File Transmission (EFT) responses, respond on underpayments or overpayments via payer portal, payer chat or payer customer service, analyze claim adjustment reason codes, analyze remittance advice remark codes and any revenue cycle activities associated with outstanding insurance balances across all Hartford HealthCare hospitals, medical group and homecare. These duties include the managing of the day-to-day work queue inflow, dashboard monitoring, weekly aging’s, Work in Progress (WIP), account activity assignment, and internal department collaboration with daily productivity and quality standards that are tracked and monitored.
Initiates strategic practices for resolving payer issues with claims, contract variances, under payments and overpayments, as well as researching insurance company issues, such as network problems and workers’ compensation claims. Communicates issues and trends to Leadership, up to and not excluding payer representatives.
Keeps abreast of all regulations and standards to ensure compliance with governmental/regulatory agencies or commercial payers. Assisting the organization to comply with all federal/state guidelines.
Responsible to meet quality standards, cost-effective products or services are delivered in support of the HHC core values, strategic plan and established Patient Financial Services goals and objectives which is not limited to HHC receiving the appropriate payment.
Position Responsibilities:
Key Areas of Responsibility
Functions as a proficient member of the team that is responsible for the timely cash collections of insurance payments for approximately $550+ million in active inventory and $70 million in denials.
When a claim is denied;
A. Takes appropriate action for payment resolution; documents all activity in accordance with standard work
B. Maximizes insurance reimbursement timely with commercial and governmental payers
C. Responds to inquiries or follow up on issues and provide information to resolve outstanding balances.
D. Resolves denials, underpayments, no pays, payer rejections, claim edits and credit balances with commercial and governmental payers
E. Discovers root cause for denials, underpayments or delay and propose opportunity
F. Discovers/identifies denials based on contract and/or fee schedule.
G. Performs due diligence in reconciling outstanding balances ensuring all efforts have been exhausted in resolving issues with payers, prior to write-off.
H. Works with leadership; to identify, trend and address root causes of issues in the AR.
Intermittently exceeds productivity and quality performance expectations.
Communicates with peers, management and internal colleagues to facilitate the flow of information. Demonstrates H3W Leadership Behaviors.
Actively seeks opportunities to model teamwork through collaboration both within and outside the workgroup in support of the organization’s objectives.
Assumes responsibility for self-improvement in collaboration with superior.
Maintains effective positive customer service, ensuring the needs are met and educating staff on the importance of quality customer service.
Functions as Daily Huddle Leader
Performs other duties as assigned
Working Relationships:
This Job Reports To (Job Title): AR Follow Up/Denials Supervisor.