Financial Representative 2
Location
United States
Posted
6 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Financial Representative 2
GuideWell Source
Role Description This position is accountable for safeguarding the Medicare Trust Fund via the timely and accurate recovery of overpaid or erroneously paid Medicare claims through depositing and recording of cash (negotiable instruments) into multiple bank accounts and into the accounting system(s). Duties include performing claims adjustments, issuing refunds, offsetting claims payments, creating extended repayment schedules, sending referrals to Treasury and verbal and written communications with appropriate entities. Incumbents are expected to participate in opportunities to learn new debt recovery functions and to work multiple workloads that can change frequently. Essential Responsibilities - The Financial Representative 2's time will be spent on moderately complex financial transactions that have a direct impact to financial statements and providers. - These transactions include Accounts Receivable and non-claim Accounts Payable, which are subject to numerous external audits. - Due to strict timeliness and accuracy standards, transactions require the utmost accuracy and completeness. - Outlined below are workloads; this does not encompass all workloads. Employees will begin with one or more workloads and will have the opportunity to be involved in more as their career progresses. Cash Receipts Solicited, Unsolicited Non-Medicare Secondary Payer (MSP): (35%) - Analyzes, researches and interprets standard/nonstandard and miscellaneous documentation received from the customer to apply solicited and unsolicited refunds received. - Determines appropriate steps to take, including but not limited to, interest owed, debt status, and appropriate resolution of cash receipts. - Performs claims and other insurance research in multiple systems, performs phone development for additional information or clarification of information received. - Performs claim history function including archive retrieval, adjustment(s), and resolves adjustment suspension. - Applies solicited and unsolicited cash receipt(s) refunded to appropriate account receivables (ARs) in Healthcare Integrated General Ledger and Accounting System (HIGLAS). This includes calculating and initiating payments for excess refunds as appropriate. Perform Appeals Activities: (30%) - Analyzes, researches, and processes overpayment appeal notices and decisions. Ceases recoupments of appeals and sends notification letters. - Determines appropriate steps to take regarding debt after appeal decision(s) are made, including reinstating of recoupment eligibility, calculating and initiating payments to refund collections of principal and interest amounts and adjusting of Accounts Receivable (AR) balances. - Generates and issues notification and revised demand letters to debtors as appropriate. Perform Collection Activities: (10%) - Generates and issues overpayment letters. Researches and works correspondence from other contractors/entities. - Documents and maintains accurate records in appropriate systems. - Analyzes, researches, and responds to correspondence. - Initiates collection calls to debtors on past due balances. - Performs research of historic and current overpayment debts as well as payments to Medicare Providers and Beneficiaries. - Analyzes, researches, and processes Immediate Offset requests. Deposit/Allocate/Control Incoming Cash Receipts: (10%) - Reconciles physical checks to internal systems and deposits checks using bank supplied hardware and software within stringent CMS timeframes. - Uploads check data into HIGLAS. - Performs corrections on deposits, processes, voids and reissues payments including undeliverable checks, Do Not Forward, and Automated Clearing House (ACH) returns. - Completes steps associated with transferring monies between contractors. - Reconciles batch deposits between internal systems, bank and HIGLAS. Miscellaneous Duties: (10%) - Creates Financial Transactions related to Accounts Payable (AP) and Accounts Receivable (AR). - Participates in meetings and work groups as needed. - Compiles and analyzes data and reports. - Participates and assists in trainings. - Collaborates with internal departments as necessary to resolve any identified discrepancies. Perform PARD Support Activities: (5%) - Performs disbursement and collection activities for Provider Audit determinations by establishing Manual Accounts Receivables, Accounts Payable (AP) and performing manual netting. - Inputs changes related to Periodic Interim Payment/Pass-Thru biweekly payments. - Initiates/Releases Cost Report and Credit Balance holds. - Performs credit balance activities including establishing AR's, generating and sending letters. Qualifications - High School diploma or GED - 2 years' related work experience in one or more of the following: banking, including customer service, transaction processing; financial transactions including but not limited to accounts receivable, accounts payable, balancing registers, cashiering, billing, invoicing and collections; insurance including claims processing, customer service, administrative supports, etc. - Experience working with Microsoft Office products such as Excel, Outlook and Word - Experience with numeracy skills: adding, subtracting, multiplying, dividing, comparing numbers - Experience preparing, revising, and editing grammatically correct written responses to correspondence - Experience effectively managing time, prioritizing work, and adjusting to changing priorities to meet deadlines - Experience following written procedures or guidance - Demonstrated analytical, organizational, problem solving, reading comprehension and decision-making skills - Demonstrated flexibility and willingness to transition between various functions - Demonstrated written, verbal and interpersonal communications skills Requirements - Experience working in Medicare or other insurance experience - Experience performing in-depth research in areas such as online manuals, payment and financial systems, network drive filing systems - Experience working in a production environment and handling multiple, changing priorities - Experience handling unique/new workloads that arise from external changes - Experience navigating multiple systems and screens - Experience using Healthcare Integrated General Ledger and Accounting System (HIGLAS), Multi Carrier System (MCS), Fiscal Intermediary Shared System (FISS), Debt Recovery Connect (DRC), OMNI, System for Tracking Audit and Reimbursement (STAR), Overpayment Appeals Tracking System (OATS), EDoc or any accounting system Benefits - Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire - Short- and long-term disability benefits - 401(k) plan with company match and immediate vesting - Free telehealth benefits - Free gym memberships - Employee Incentive Plan - Employee Assistance Program - Rewards and Recognition Programs - Paid Time Off and Paid Sick Leave Company Description We are an Equal Opportunity/Protected Veteran/Disabled Employer. This opportunity is open to remote work in the following approved states: AL, FL, GA, ID, IN, IO, KS, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require additional approval. In FL and PA in-office and hybrid work may also be available.
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