Account Representative (TCWS) Pavilion
Medical Center, Houston, TX
Shift and Salary Grade
Shift: 8am-5pm, Full Time
Salary Grade: 7
Provide collections follow-up on assigned accounts to ensure account resolution. Assist with the application process of charity or payment plans for the guarantors and families needing assistance. Responsible for appealing underpayments and technical denials within each payors contractual guidelines and government regulations. Work closely with other departments to retrieve information supporting appeals and communicating denial trends.
Initiate collection calls to payors or guarantors to verify receipt of claims/statements and collect on outstanding accounts receivables; document expected payment, check number and amount to be paid; ensure payments received are correct and the proper contractual discounts/allowances have been applied; analyze and assess accounts for uncollectable balances. Research denied claim by contacting payor and review EOB or R&S; determine level of appeal to pursue; compose appeal letter identifying reason for denial and explanation. Maintain assigned accounts receivable at or below specified targets and goals.
Knowledge and Skills:
Knowledge of government, commercial and managed care reimbursement methodologies and understanding of all federal, state and local legal aspects of collection regulations; knowledge of how managed care plans work and the requirements for insurance coverage and benefits. Ability to communicate effectively (oral and written); good interpersonal skills; decision-making skills; professional courtesy; ability to operate a PC and general office equipment. Strong math aptitude in order to be able to verify the appropriate reimbursement based upon the contract terms, benefits and/or government regulations.
Education and Experience:
High school diploma. Two (2) years in collections, preferably in a hospital setting required.
About Texas Children's
Texas Children's Hospital Pavilion for Women
Expanding upon Texas Children's Hospital reputation in fetal and neonatal medicine, the Pavilion for Women, located in the Texas Medical Center offers a full range of maternal, newborn and gynecological services, all in one location.
The Pavilion for Women will advance the hospital's mission with a full range of obstetrical services including but not limited to: evaluation and consultation, preterm birth evaluation, perinatal diagnostic and treatment services, childbirth and parenting education classes and lactation and psychosocial support services.
In addition, expectant mothers have access to a full spectrum of fetal therapies and for infants in need of specialized care, the Pavilion for Women offers both a Level II and Level III Neonatal Intensive Care Unit (NICU), as well as access to expert pediatric subspecialists representing more than 40 specialty areas, all in one location.
The Pavilion for Women also provides a full range of gynecological care, from annual well care checkups to highly specialized procedures and minimally invasive surgeries.
No third party considerations will be accepted at this time. Vendors please do not call HR directly to solicit.
Parents in the Lone Star State can rest easy knowing Texas Children's Hospital has the doctors and facilities to diagnose and treat...