Franciscan Missionaries of Our Lady Health System

• The Patient Accounts Representative 2 works with patients, co-workers and external agencies to ensure the prompt payment and/or reimbursement of hospital and/or professional charges. • Responsible for the monitoring of patient accounts which includes claim submissions, researching and reviewing back end denials, determining appropriate action for submission of provider claims, outbound and inbound calls from insurance carriers, providers and patients, payment posting, collections, account adjustments and appeals.

• This position is accountable for the collection, completion, and verification of the accuracy of all patient data collected for the Trauma Registry data collection system. The Registrar creates and maintains clinical and statistical data, AIS coding, ICD10CM codes and abstracts various data elements required ensuring consistency and quality in all aspects of the system through data collection. • Responsibilities include daily monitoring of trauma admissions for record identification, abstracting, coding and entering data into the registry.

• Assists in the development and maintenance of financial information related to volume, financial performance, and profitability for each managed care contract. • Prepares preliminary interpretations of analysis for project teams, departments and/or management. • Assists in developing reimbursement strategies and policies and procedures related to contract negotiations. • Obtains and maintains current information and knowledge of the managed care environment, including but not limited to local, state and national developments; and develops and maintains relationships with appropriate agencies. • Assists in contract negotiations. • Ensures that changes in managed care processes are communicated to and followed by FMOLHS and affiliated entity employees in a manner that ensures high quality patient care. • Strives to promote the quality and efficiency of his/her own performance by remaining current with the latest trends in field of expertise through participation in job-relevant seminars and workshops. • Works collaboratively with internal departments (i.e., Financial Operations, Revenue Management, Business Office, etc.) to ensure reimbursement is optimized and to resolve identified issues. • Assists in the resolution of identified operational issues with contracted payers. This includes resolution of reimbursement, operational and clinical issues. • Works with affiliated entities in the development and maintenance of managed care contracts and strategies.

• Revenue and Reimbursement Management • Insures the appropriate bundling or unbundling of charges so that all charges are submitted result in maximum reimbursement while following applicable billing, coding and reimbursement regulations. • Interprets Medicare transmittals to determine whether new codes, coding changes, or directives that alter billing and compliance are required and to communicate these changes to all relevant departments. • Proactively identifies new charge opportunities and makes monthly recommendations to prevent future billing problems. • Manages the process of CDM maintenance including the training and supervision of staff in order to process CDM request in a timely response to decrease bill rejections and payment delays due to chargemaster driven coding and charging issues. • Effectively utilizes all internal automation and software applications. Prepares reports as required by management regarding process improvement recommendations and systematic claim processing issues. • Answers questions regarding hospital and departmental operations, policies and procedures. • Assist Payer Relations with contract analysis to receive maximum reimbursement. • Develop or modify revenue and reimbursement reports to prevent a disruption in the revenue stream. • Quality • Safeguards the hospital against exposure to denials, penalties and fines by ensuring healthcare services are billed accurately and properly at all times. • Coordinates and performs the analysis of the yearly charge change recommendations and pricing schedule changes recommended by the contracted Revenue Consultants. • Collaboration and Partnership • Assists the billing personnel in resolving third party payor billing problems and works to streamline the revenue cycle in coordination with Department Managers, Business Office, HIM and Managed Care to increase charge capture, receive accurate payments from payers and minimize claim denials. • Assists departments in coordinating, compiling and interpreting information regarding health care services and operating costs in an effort to create efficient charging practices and the capture of appropriate revenue. • Performs in-house education regarding revenue cycle/indicators for Department Managers. • Other Duties As Assigned • Performs other duties as assigned or requested.

• Accurately and efficiently registers patients in Epic. • Monitors and manages the flow of patients through the clinic utilizing initiative to ensure the patient experience is best in class. • Monitors patient schedules and reviews accounts to determine the patient's financial responsibility on account balance and arranges payment plans to collect. • Assists patients with access to government and community resources to enhance their access to health care services. • Works closely with physicians, nurse practitioners and nursing staff to ensure that referrals to other providers/services/facilities are completed in accordance with payor requirements in a timely manner. • Facilitates the patient's access to information including but not limited to MyChart access. • Accurately updates patient records as needed. • Accurately enters patient charges as necessary.

• The Patient Accounts Representative 2 works with patients, co-workers and external agencies to ensure the prompt payment and/or reimbursement of hospital and/or professional charges. • The Patient Accounts Representative 2 is responsible for the monitoring of patient accounts which includes, but is not limited to: claim submissions, researching and reviewing back end denials; determining appropriate action for submission of provider claims; outbound and inbound calls from insurance carriers, providers and patients; payment posting; collections; account adjustments and appeals.

• Answers and responds to incoming phone calls in adherence with protocol and service standards • Provides assistance to managers and employees with time-sensitive requests, such as HRIS (Lawson) navigation, etc. • Provides first-level assistance to managers and employees with HRIS self-service tools • Assists employees and managers in all stages of the employee life cycle (onboarding, job changes, retirement, etc.) • Initiates contact or makes referrals to the appropriate resource for situations that require specific attention or on behalf of other HR Centers of Excellence (CoE) • Investigates, and resolves first level Human Resources and benefits issues. • Maintains accurate and timely documentation and recordkeeping related to human resource and benefit activities in the designated database(s) and in adherence with human resource and benefit policies and applicable regulations. • Participates in and share expertise during team meetings and training sessions.

• Process observation requests and conduct provider orientations. • Maintain on-call schedules, schedule provider shifts, and coordinate on-call payment processes. • Conduct surveys and ensure compliance with regulatory standards, accrediting agencies, and Medical Staff Bylaws. • Serve as a provider liaison with the System Verification Office for timely credentialing. • Coordinate meetings and manage committee action items. • Assist in troubleshooting and resolving credentialing issues when needed. • Participate in investigations or disciplinary actions impacting medical staff members. • Collaborate on shift schedules, job openings, new provider orientations, and staffing needs. • Handle special projects as assigned.

• Facilitates EPIC vision development, solution design, standards guidance, project scoping, IS strategy integration and implementation of efficient, high-quality technology and applications systems. • Evaluates technology, systems and application capabilities, analyzes workflow/data flow, and creates efficient and logical solutions. Plans, schedules, reviews, and performs analysis, design, construction, testing, and implementation of assigned technology and application systems. Participates in solution testing and documents clear and concise system descriptions that meet project requirements and departmental quality standards. • Collaborates with FMOLHS Information Services, leaders, team members and end users to develop efficient, cost-conscious technology and applications system specifications that maximize organizational performance.

• Facilitates Epic vision development, solution design, standards guidance, project scoping, IS strategy integration and implementation of efficient, high quality technology and applications systems. • Evaluates technology, systems and application capabilities, analyzes workflow/data flow, and creates efficient and logical solutions. Plans, schedules, reviews, and performs analysis, design, construction, testing, and implementation of Epic and related application systems. Participates in solution testing and documents clear and concise system descriptions that meet project requirements and departmental quality standards. • Collaborates with FMOLHS Information Services, leaders, team members and end users to develop efficient, cost-conscious technology and applications system specifications that maximize organizational performance. • Develops and implements data driven performance improvement methodologies. Maintains accurate records for use in evaluating organizational performance. Identifies ways of improving current services and consults with management on issues and problems. • Ensures security, integrity, and privacy of FMOLHS data in conjunction with FMOLHS policies and procedures. • Strives to promote the quality and efficiency of his/her own performance by remaining current with the latest trends in field of expertise through participation in job-relevant seminars and workshops, attendance at professional conferences, and affiliations with national and state professional organizations.