Oneida Health is an independent 101-bed acute care community hospital and a 160-bed extended-care facility (ECF) and short-term rehab facility licensed by the State of New York and operated by Oneida Health Systems, Inc., a New York not-for-profit corporation. The hospital is Joint Commission accredited.
We are proud to share that we have recognized for several national awards based upon safety of care as well as the patient experience of care. The first recognition is provided by The Leapfrog Group, a nationally recognized non-profit organization who reviews 30 patient quality and safety measures and assigns a letter grade to over 2,600 hospitals nationally based upon outcomes. The fall 2019 letter grade for OHC is a “B.”, our eighth consecutive “A” or “B”. Our hospital was also awarded 4 Stars for Patient Experience.
The second recognition is for the Healthgrades Patient Safety Excellence Award. Our hospital is among the top 10% nationally for patient safety and is 1 of only 16 hospitals in New York to receive this award for 2019. The third recognition is for the Healthgrades Outstanding Patient Experience Award. Our hospital is among the top 10% nationally for patient experience and is 1 of only 8 hospitals in New York to receive this award for 2019…with Oneida Health as the only hospital in New York State to receive both awards for 2019! We are also very proud of our CMS 4-Star overall rating for patient experience and CMS 5-Star for quality measures.
The Patient Account Representative – Collections and Follow up Specialist performs all collection and follow up activities with third party payers; Medicaid; Medicare; Commercial; HMO’s; Third Party Liability; and Workers Compensation to resolve all outstanding balances and secure accurate and timely payment. This position is responsible for supporting and contributing to the team efforts in the achievement of pre-established accounts receivable performance goals of:
- Net and Gross Days outstanding in Accounts Receivable
- Percent of Accounts receivable aged greater than 90 days
- Cash Collection Goals
- Credit Balances as a Percent to outstanding receivables
- Denials Resolution
The Patient Account Representative Collections and Follow up Specialist performs daily activities related to the successful closure of aged accounts receivable
- Perform Account Statussing and Follow up
- Resolve Credit Balances
- Respond to and resolve claim payment denials
- Correspondence resolution
- Performs daily collections activities which would include but are not limited to performing on line account status checks, and contacting payers to follow-up on outstanding claim balances of assigned accounts in work ques. Clearly documents in the patient account notes, the payment status of the account and/or actions taken to secure payment. If applicable, re ques account for additional follow up activity within a prescribed number of days.
- Performs required actions in order to resolve the account balance promptly by submitting appeals, correcting account information, coordinating requests for medical records, requesting posting of account adjustments, requesting an account re bill and any and all other actions necessary to secure account payment. Documents and tracks turnaround time of receipt of any outstanding documents required from external departments.
- Reviews credit balances of assigned accounts; determines action needed and takes appropriate action to clear the credit balance including but not limited to rebills, request for refund check, payer contact to determine source of credit balance and method of return. Clearly documents account as to actions.
- Responds to claim denials from payers such as inability to identify the patient, coordination of benefits; non-covered services; past filing deadlines and ensures all information is provided to the payer that is required to process payments within 24 hours of receipt.
- Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others.
- Performs routine audits of assigned individual accounts to resolve all discrepancies in account balances – credit balances, underpayments, inaccurate contractual allowances and performs necessary actions to resolve the account balance.
- Informs the supervisor of any problems or changes in payer requirements and exercises independent judgment to analyze and report repetitive denials so that corrective actions can be taken.
- Achieves established productivity standard as determined by the Collections and Denial Management Supervisor. Tracks productivity and provides cumulative reports on a daily, weekly or monthly basis, as required by supervisor.
- Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact patient account collections. Adheres to internal controls for applicable state/federal laws, and the program requirements of accreditation agencies and federal, state and private health plans.
- Seeks advice and guidance as necessary to ensure proper understanding.
- Effectively utilizes payer websites as needed in the execution of daily tasks.
- Monitors assigned work lists at all sources and insures expeditious resolution. Works with other departmental representatives in resolve. Reports unresolved issues and concerns impeding the collection process and to ensure successful account resolution.
- Complies with patient confidentiality policies for the retention of patient health information, or when handling, distributing, or disposing of patient health information.
- Seeks advice and guidance as necessary to ensure proper understanding.
- Performs other duties as assigned by the Supervisor.
Additional Knowledge, Skills and Abilities
- Handles telephone information with courtesy, accuracy, and respect for confidentiality; receives information and distributes messages appropriately
- Consistently communicates appropriately with patients and staff and responds to requests for assistance promptly.
- Provides accurate communication in verbal, non verbal and written form. Listens effectively.
- Communicates effectively with supervisor, including but not limited to changes of operation. Reports to supervisor regularly on the status of ongoing projects.
- Assists with orientation of new staff
- Follows proper chain of command appropriately to resolve problems and concerns
- Treats patients and their families with respect and dignity, and ensures confidentiality of patient records.
- Provides positive and productive support to the team and promotes teamwork. Is kind, courteous, respectful and professional in all interactions with all hospital personnel at all levels.
- Two + years experience directly related to health care claims collections.
- High School diploma or GED
- Familiarity with healthcare medical terminology and coding
- Basic knowledge in the reimbursement guidelines for all major third party and governmental payers; Medicaid, Medicare, HMO’s; Commercial, Worker’s Compensation and Third Party Liability
- Good communication and interpersonal skills
- Basic knowledge of PC and Microsoft Office Suite use and application and use of internet
- Knowledge of patient accounting systems
- Understands and complies with HIPAA and Protected Health Information rules and regulations
Compensation / Benefits
Competitive salary and excellent benefits, including 403(b) with both matching and discretionary contributions, generous health insurance benefits, paid life/LTD insurance and 29 paid days off to start.
About Oneida Healthcare
Oneida Healthcare’s patients never have to sacrifice local accessibility for world-class care. Over twenty local care centers and our community of 150 employed and private-practice physician partners means an ever-expanding pool of professional expertise, progressive medical technology and treatment options.
Oneida Healthcare provides ready access to a full complement of services including: 24/7 Emergency Department; Modern Inpatient Facilities; EHR; State of the Art Operating Suites; da Vinci Robotic Surgery; Modern Birthing Center; Outpatient Rehab Center; Hospital-Operated Primary and Specialty Care Practices and a 160-bed Skilled Nursing and Rehab Center. The Circle of Caremeans “Exceptional Care…Always!”
Oneida, NY is a unique community with beautiful tree lined streets, sprawling parks and playgrounds, and convenient shopping. Available housing includes everything from wonderful old 19th century Victorians, to condominiums, to the house of your choice in a variety of new developments. Oneida and neighboring communities offer excellent school systems with records of academic excellence and student success. The city also boasts a progressive library, and many other easily accessible services. Oneida is equidistant between Syracuse to its west and Utica to its east, with beautiful Oneida Lake just 5 miles north. Finger Lakes wine country and the majestic Adirondack mountains are easy day trips, with Toronto, Montreal, Boston, Philadelphia and New York City all within a 5 hour drive. Syracuse University sports are a major source of regional pride and excitement and two world class shopping and entertainment destination – Turning Stone Casino and Destiny USA – are just minutes away.