About Us:
Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.
We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
JOB SUMMARY:
Account Executives are subject matter experts of zero balance projects, conducting in depth research of hospital contracts, data, and other sources to address client questions. They manage external project relationships, which includes compiling and presenting reports and analysis. They also manage internal projects and assignments.ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.
Account Executives are subject matter experts of zero balance projects, conducting in depth research of hospital contracts, data, and other sources to address client questions. They manage external project relationships, which includes compiling and presenting reports and analysis. They also manage internal projects and assignments.
Role & Responsibilities:
- Manage client projects and relationships by participating in meetings, managing action items through to completion, answering client questions, and independently writing client emails
- Compile, QA, and independently manage client processes from start to finish, such as provider relation escalations, bulk issues, regular reports, and invoices
- Manage internal staffing and project needs, including answering questions from other team members on assigned client and monitoring project profitability
- Research and determine next steps for complex and new payer issues and reimbursement areas to uncover potential opportunities, such as reimbursement guidelines and healthcare legislation
- Create and update project plans, including outlining potential risk areas of a hospital-payer contract based on reimbursement structure and how to manually identify within the data
- Review and summarize pricing documents based on hospital contracts to calculate expected payments, including Medicaid, percentage of charge, per diems, Medicare IPPS, MSDRG, outlier and/or stoploss, implants, drugs, and other reimbursement models
- Make thorough client observations and recommendations after completing a project audit regarding underpayment exposure, contract risk, and other potential issues
- Work with other account executives and managers to effectively submit bulk listings of accounts to insurance companies for reprocessing (e.g. rebill)
- Escalate accounts to insurance provider relations for resolution and payment, including corresponding appropriately with provider relations teams, tracking progress of issues and ensuring that deadlines are met
- Examine feedback from other internal teams on project activity and provide teams appropriate direction regarding account action when auditing and/or pursuing payments
- Contribute meeting content to team meetings, AC biweekly meetings, and internal project related meetings
- Help create and implement process improvements and trainings to protect future revenue
- Understands and implements best practices for internal processes, communication, and documentation
- Other duties as assigned
Skills & Experience
- A minimum of 3 years of experience in areas of research and analysis
- A minimum of 3 years of verifiable work history
- A minimum of 3 years of experience with managed care contracts and hospital reimbursement
- A minimum of 2 years of experience working with clients or equivalent
- Must have achieved High School Diploma or GED
- 3 years of experience working in MS Office, with emphasis on advanced Excels skills, requiring experience with formulas, graphing, and reports to manipulate pricing tools and edit project reports
- Demonstrated problem solving and critical thinking skills
- Demonstrated ability to meet project deadlines
- Demonstrated excellent written and verbal communication skills, to include writing professional documents and delivering presentations.
- Diligent and strong attention to detail
Preferred Skills:
- Access: Update and link queries and tables, create steps to calculate reimbursement
- Understanding the basics of MySQL (specifically: modification in a field or table- following field and data requirements)
PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.