Accounts Receivable Representative I

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Now more than ever.

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The possibilities are endless...
 
Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize the abundant opportunities for growth and success.
 
If this describes you then let’s talk!
 
HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.

Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.

Emp Status

Work Shift

Compensation Range

What you will be doing

YEARS OF EXPERIENCE REQUIRED

Minimum one (1) year of experience in hospital and/or professional billing, insurance follow-up, customer service, patient financial services, cash posting, or a related healthcare environment.

YEARS OF EXPERIENCE PREFERRED

Previous Hospital Billing (HB) and/or Professional Billing (PB) follow-up experience preferred.

Experience with:

• Hospital billing and/or Professional billing and insurance follow-up
• Basic denial management
• Epic Resolute Hospital Billing and/or Professional Billing
• Commercial, Medicare, Medicaid, Workers' Compensation, No-Fault, and Managed Care reimbursement
• Microsoft Office Suite with emphasis in Excel
• Strong customer service, communication, organizational skills, and attention to detail
• Ability to meet productivity and quality standards within a revenue cycle environment
• Understanding of basic revenue cycle functions.
• Knowledge of claim lifecycle from billing through reimbursement.
• Basic understanding of CPT, HCPCS, ICD-10, and insurance terminology.

PHYSICAL WORKING CONDITIONS

Sitting in a comfortable position with frequent opportunity to move throughout the department and hospital campus. Frequent use of computers, telephones, and standard office equipment.

ENVIRONMENTAL WORKING CONDITIONS

Comfortable indoor office environment.

HAZARDS OSHA

Category 3

Tasks involve no exposure to blood, body fluids, tissues, or other potentially infectious materials. Category 1 tasks are not a condition of employment.

POSITION & UNIT ACCOUNTABILITIES

Resolves Payor Issues

• Reviews assigned Hospital Billing (HB) and/or Professional Billing (PB) workqueues for routine unpaid or pending insurance claims.
• Contacts insurance carriers regarding claim status, missing information, and routine reimbursement issues.
• Research payer responses and follows established departmental workflows to facilitate timely reimbursement.
• Escalates complex reimbursement issues requiring additional review.

Supports Claim Resolution

• Reviews routine denial information and identifies appropriate next steps.
• Assists with corrected claims, reconsiderations, appeals, and supporting documentation as directed.
• Coordinates with internal departments to obtain information needed for claim resolution.
• Supports timely resolution of assigned accounts.

Maintains Documentation & Account Information

• Maintains complete, accurate, and timely account documentation.
• Documents payer communications, account activity, and follow-up actions.
• Updates claim history to support continued account resolution.
• Maintains documentation in accordance with departmental standards.

Coordinates Interdepartmental Communication

• Communicates with Coding, HIM, Patient Access, Billing, Cash Posting, and other departments regarding routine claim issues.
• Routes accounts requiring additional review with supporting documentation.
• Monitors routed accounts and follows up as appropriate.
• Escalates unresolved issues when departmental turnaround times are exceeded.

Productivity & Operational Performance

• Achieves established productivity, quality, aging, and inventory management benchmarks.
• Maintains assigned inventory in accordance with departmental service level expectations.
• Supports departmental accounts receivable reduction and cash collection goals.
• Participates in departmental process improvement initiatives.

Compliance

• Ensures follow-up activities comply with payer regulations, hospital policies, and departmental procedures.
• Protects confidential patient and financial information in accordance with HIPAA requirements.
• Maintains current knowledge of payer policies, Epic workflow updates, and departmental procedures.

Team Collaboration

• Participates in departmental meetings, huddles, training sessions, and quality reviews.
• Communicates effectively with peers and internal departments.
• Demonstrates flexibility with changing work assignments and departmental priorities.
• Maintains satisfactory attendance and punctuality.

EDUCATION REQUIRED

High School Diploma or equivalent (G.E.D.), may include specialized or vocational courses.

EDUCATION PREFERRED

Associate’s degree in healthcare administration, Business Administration, Health Information Management, or related field preferred.

CERTIFICATIONS / LICENSURE REQUIRED

None.

CERTIFICATIONS / LICENSURE PREFERRED

• Certified Revenue Cycle Representative (CRCR)
• Certified Professional Biller (CPB)
• Other healthcare revenue cycle certifications preferred.

SKILLS REQUIRED

• Insurance follow-up and account resolution
• Hospital Billing (HB) and/or Professional Billing (PB)
• Basic denial management
• Ability to navigate Epic Resolute Hospital Billing and/or Professional Billing workqueues, account activity, claim history, and follow-up documentation functions.
• Microsoft Office Suite
• Customer service
• Effective verbal and written communication
• Attention to detail
• Organization and time management
• Ability to manage assigned inventory and prioritize workload

SKILLS PREFERRED

• Epic Resolute Hospital Billing and/or Professional Billing experience
• Knowledge of payer reimbursement methodologies
• Insurance follow-up and basic denial resolution
• Commercial, Medicare, Medicaid, Workers' Compensation, No-Fault, and Managed Care follow-up
• Ability to identify routine claim issues and escalate complex reimbursement concerns appropriately

Non-Discrimination Policy
Hospital for Special Surgery is committed to providing high quality care and skilled, compassionate, reliable service to our community in a safe and healing environment. Consistent with this commitment, Hospital for Special Surgery provides care, admits, and treats patients and provides all services without regard to age, race, color, creed, ethnicity, religion, national origin, culture, language, physical or mental disability, socioeconomic status, veteran or military status, marital status, sex, sexual orientation, gender identity or expression, or any other basis prohibited by federal, state, or local law or by accreditation standards.