At Wellstar Health System, our mission is to enhance the health and well-being of every person we serve. Nationally ranked and locally recognized for our high-quality care, inclusive culture and world-class doctors and caregivers, Wellstar is one of the largest, most integrated healthcare systems in Georgia. Our specialists and primary care providers work in a multidisciplinary environment with nearly 25,000 diverse team members throughout our hospitals, health parks and medical offices. Communities can also access our outpatient centers, a pediatric center, nursing centers, and hospice and home care services. We’re proud to be home to the second-largest Emergency Department in the country, as well as being the only system in Georgia operating multiple trauma centers. We’re also known for our exceptional work culture, featured on the Great Places to Work®, Fortune 100 Best Companies to Work For® and the Seramount Best Company for Multicultural Women® lists. We continue to attract the best and the brightest in healthcare.At a time when our industry is changing rapidly, Wellstar remains committed to exceeding expectations from our patients and team members, while transforming healthcare delivery. We stand behind our values to serve with compassion, pursue excellence and honor every voice.

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Job Posting

A Brief Overview

The Account Resolution II representative is responsible for ensuring all eligible accounts are reviewed appealed within the designated payer timeframes and are documented appropriately in the patient accounting system. Additionally, the Account Resolution II representative will be responsible for the tracking and trending of recovery efforts by utilizing various departmental tools and appropriately reporting on-going problems specific to payers, health system departments, and/or contracts. The Account Resolution II representative will work collaboratively with their Team Lead, Manager and other area Leaders to ensure necessary communication and feedback to the departments take place in a timely manner. The Account Resolution II representative serves as a mentor to Account Resolution I representatives as well as own several inter/intradepartmental projects.

What you will do

Duties and Responsibilities
- Collect and resolve payments from insurance companies by working with assigned payers and utlizing Policies and Procedures
- Execute and assist team members with the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner. Research and resolve payer rejected/denied claims and analyze accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract. Work with clinical staff as needed to follow-up and appeal denials. Follow Adjustment Policy for denials where efforts have been exhausted.
- Maintain data on the types of claims denied and root causes of denials, and collaborate with team members to make recommendations for improvement and issue resolution
- Prepare, maintain, assist with and submit reports as required.
- Track and trend recovery efforts by utilizing various departmental tools. Escalate on-going problems to Manager/Team Lead for appropriate action to resolve.
- Provide feedback and process improvement ideas to management regarding facility, Patient Access, Case Management, HIM, Billing and/or payer issues identified when reviewing accounts for appeal
- Identify contract issues related to denials and no response; communicate those issues to the team Manager.
- Provide on-going feedback to clinical staff about denial reasons, appeals and their outcomes, and managed care contractual requirements.
- Transmit required documentation to Government and third-party payers for the purpose of resolving payments
- Ensure all payer contact is fully documented in the appropriate software application
- Ensure claims are crossed over to secondary insurances, reporting any delay in unbilled secondary claims to the unit supervisor
- Consistently meet the current productivity standards in addressing and resolving accounts.
- Consistently meet the current quality standards in taking appropriate actions to identify and track root causes, successfully appeal denied accounts, and trend issues, avoid excessive deferred accounts. Help Team Lead and Manager educate team appropriately.
- Complete special projects as assigned.
70%
Management
- Provide individual contribution to the overall team effort of achieving the department AR goal
- Identify opportunities for system and process improvement and submit to management
- Demonstrate proficient use of systems and execution of processes in all areas of responsibilities
- Follow the health system’s general Policy and Procedures, the Department’s Policy and Procedures, and the Emergency Preparedness Procedures
- Become cross-trained and fill in for other staff as assigned. Train new employees.
- Administer quality audits as assigned by Manager or Director.
20%
Administrative
- Professional Communication
  - Assure patient privacy and confidentiality as appropriate or required
  - Communicate in a professional manner with patients, their families and representatives from third party payor organizations including physicians, physician staff, co-workers, management and clinical staff.
  - Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies
  - Initiate communication with peers about changes and procedures
  - Interact with internal customers including HIM, Revenue Integrity, Patient Access, and the SBO in a professional manner to achieve revenue cycle department AR goals and objectives
- Department Methods/Procedures/Operations
  - Follow department guidelines for lunch, breaks, requesting time off, and shift assignments
  - Operate office equipment and machinery and utilizes ergonomic workstations, equipment, and supplies
  - Follow JCAHO and outside regulatory agencies’ mandated rules and procedures
  - Utilize assigned menus and pathways in foreign software applications. Report software application problems to the appropriate supervisor
  - Perform other duties and responsibilities as assigned
10%

Qualifications

High School Diploma General Required and(
GED General Required or)

Minimum 3 years collection experience and/or with a Hospital Information System or PC-based application Required
Less than 1 year experience as an Account Resolution I or equivalent Required

Our people are passionate about what they do, the product they sell, and the customers they serve. If you're looking for an opportunity to be an opportunity to be a part of a work family that values collaboration, innovation and dedication, we're the right company for you.

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.

Account Resolution 2 MGBO WMCG

Offer summary

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