University of Washington Physicians (UWP) is the practice group for more than 1,800 physicians and other healthcare professionals associated with UW Medicine. In addition to UWP, UW Medicine includes Harborview Medical Center, UW Medical Center, UW Neighborhood Clinics, Northwest Hospital, the UW School of Medicine, Valley Medical Center, and Airlift Northwest. UWP members also practice at the Seattle Cancer Care Alliance, a partnership of UW Medicine, Fred Hutchinson Cancer Research Center, and Seattle Children’s Hospital.
The Patient Account Representative Lead (Insurance Follow Up) is responsible for analyzing and developing more efficient and effective workflows for insurance denials and other assignments worked by the Patient Account Representatives. Additionally, the employee performs Patient Account Representative work to cover for absences and prevent backlogs; recommends improvement opportunities; and is familiar with all job functions of the department. The Patient Account Representative Lead will participate in on-the-job training thus the employee must possess superior claims management knowledge and skills, support learning and development opportunities for staff and effectively use one-on-one instructional techniques.
Minimum Qualifications: •High School graduation or equivalent AND three years of experience in patient accounting, customer service, or a related office environment OR equivalent education/experience.
Desired Qualifications: •3 years claims, collections, billing, or patient relations office experience, including insurance appeals, charge posting, posting payments and adjustments. •Prior lead or training experience preferred. •Experience in an academic healthcare environment preferred.
Essential Duties and Responsibilities: •Work timely and accurately in assigned claims follow-up queues and other assignments. •Accurately decipher denial reason and prospectively plan follow-up steps. •Effectively communicate in writing and verbally with payers. •Utilize epic functions to work claims (includes selecting appropriate appeal letter, NRP action, adjustment versus void action). •Maintain clear and concise narrative on practice management system of steps taken to facilitate resolution of outstanding claims/issues. •Display sound judgment in choosing method of follow-up (includes appeal, adjustment, e-mail, websites and telephone inquiries). •Maintain fair work volume when compared to peers. •Take proactive measures for claims follow-up to proper adjudication and use analytical skills to trend and shares denial details. •Work collaboratively with Practice Advisors and other UWP departments including Compliance, Charge Capture and Payment Posting. •Share specific payer and coding information with team members as appropriate. •Make use of tickler and reminder tools to follow-up timely. •Demonstrate innovation in choice of resources used to assist in adjudication such as fee schedules, code correct, CPT references •Respond satisfactorily and timely to requests from Patient Account Representatives regarding questions from patients and their advocates. •Take accountability for area of expertise in searching for answers to questions. •Create an atmosphere that maximizes communication; this includes adjusting for different communication styles. •Provide coding feedback to pro-fees as appropriate. •Responds to written correspondence and telephone inquiries from insurance companies or agencies regarding claims. Follow through with the request until there is resolution. •Uses payer websites and other resources, i.e. CMS, OneHealth Port, WA Med Web, ProviderOne. •Respond timely to payer requests. •Keep current with payer updates and applies knowledge to assist in payment of claim. •Review, correct, and submit computer generated claim forms (electronic and paper) to the appropriate payer. •Accurately complete claim edit work queues daily. •Use correct appeal/resubmit functions to prevent duplicate denials. •Display a solid understanding of individual payer policies. •Keep up to date with current research and practices in claims submission and coding Guidelines. •Work with the Manager and Supervisor to analyze, develop and implement improved workflows. •Observe employees at work, provide feedback, and facilitate problem solving to enhance performance of team members: oAddress employee’s specific gaps in skill or experience through guidance and encouragement. oIntroduce new procedures or technologies. oHelp build strong workplace relationships and promotes a positive work environment through open and constructive communication. oMotivate, encourage and challenge staff. oProvide help and support when needed. oWork collaboratively with the training department to develop effective desk level support training. oMentor and train staff to support achievement of quality assurance expectations. •Assist the Manager and Supervisor with any special projects or tasking that routinely develop. Ensure completion on a timely basis. •Assist Insurance Follow-up Specialists with problem accounts in their work queues, including problems working with difficult payers. •Perform other duties, as assigned.
Founded in 1861, the University of Washington is one of the oldest public institutions in the west coast and one of the preeminent research universities in the world. The University of Washington is a multi-campus university comprised of three different campuses: Seattle, Tacoma, and Bothell. The Seattle campus is made up of sixteen schools and colleges that serve students ranging from an undergraduate level to a doctoral level. The university is home to world-class libraries, arts, music, drama, and sports, as well as the highest quality medical care in Washington State and a world-class academic medical center. The teaching and research of the University’s many professional schools provide undergraduate and graduate students the education necessary toward achieving an excellence that will serve the state, the region, and the nation. As part of a large and diverse community, the University of Washington serves more students than any other institution in the Northwest.