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Job Summary

The Accounts Receivables (A/R) Representative assists in review and resolution of hospital claims under general supervision of the Patient Financial Services Supervisor.

RESPONSIBILITIES:

·       Monitor work queue (WQ)s containing claim errors, Discharged not Billed (DNB)s and rejections and perform timely submission.

·       Possess a good understanding of different types of medical insurance carriers and their claim requirements. Recognize the areas of revenue cycle and their role in accurate claim information and work with these departments to resolve bill/claim edits.  

·       Understand Explanation of Benefit (EOB)/Remits.

·       Respond to Vendor requests in a timely and professional manner.

·       Perform necessary maintenance to accounts in the billing system.

·       Perform timely follow-up with third-party insurance carrier (Government and Non-Government entities) on unpaid, underpaid, and denied facility accounts/claims.

·       Take appropriate action to resolve problems causing delay in reimbursement. 

·       Timely review, documentation and appropriate action on incoming Payer and Patient correspondence. 

·       Identify and report Payer denial, or underpayment trends to Supervisor and or Management. 

·       Verify account insurance liability (bucket) and patient liability (bucket) is correct.

·       Post, balance, and reconcile patient account payments for Accounts Receivable. 

·       Accept and process assigned batches electronically within the Hospital billing module; correcting remittance errors generated after processing. 

·       Monitor and correct errors routed to work queues; responsible for correcting errors and clearing work queues regularly. 

·       Post self-pay remittance files to respective guarantor accounts in the system. Manually post EOB files and paper checks received from the lockbox. Post denial information and other pertinent follow-up information. Close each batch by verifying all payments have been posted appropriately and reconciled to the cash control amount specified.   

·       Responsible for posting insurance recoupments using designated debit or credit payment codes.

·       Monitor A/R Aging by payer to ensure billing has been submitted timely for primary and secondary payers.

·       Collect Private pay balances to ensure statements are processed and paid promptly.

·       Ability to review Division of Family and Children Services (DFCS) notices vs Gammis to ensure correct patient liability is calculated for each account (in an attempt to not have unnecessary credit balances).

·       Respond to Vendor requests in a timely and professional manner.

·       Perform necessary maintenance to accounts in the billing system. 

·       Utilize appropriate in-house adjustment codes and activity codes; Meet productivity and quality standards as described in the department policy and procedures.  

·       Attend and/or complete all required department training. 

·       Assist where necessary with end of month reconciliation procedures.

·       Prepare supporting documentation for Leadership.

·       Other duties as assigned.

- Must be able to accurately type 30 WPM and successfully complete competency exam with 80% proficiency.

- Must possess business knowledge and results oriented experience within Patient Financial Service and demonstrated knowledge and experience with the Microsoft Suite skill set to include Excel and Word.
 
- Must be highly motivated and detail oriented with excellent teaming skills and possess excellent communication, time management, and organizational skills.

- Must possess the ability to be flexible, work collaboratively among internal and external departments, and effectively investigate, analyze, and solve problems.

QUALIFICATIONS:

• Hands on knowledge of Current Procedural Terminology (CPT), International Classification of Diseases (ICD-9) coding, Healthcare Common Procedure Coding System (HCPCS), revenue codes and hospital billing terminology. Knowledge of Outpatient Code Editor (OCE) and Correct Coding Initiative (CCI) edits.
• Job related experience in health care revenue cycle.
• Demonstrated service and success in teamwork and consistent high productivity and quality.
• Working knowledge of Medicare Secondary payer as well as medical necessity requirements.
• Epic experience
• Hands on Knowledge of Medicare and Medicaid regulations, experience with Uniform billing – UB-04 and healthcare finance administration (HCFA), 1500 claims forms billings and follow up functions both electronic and manual.

Preferred: Billing background (Hospital and physician billing)

EDUCATION:

2 years of college (Associate Degree)

Core Competencies
These competencies reflect the values and behaviors expected of all Grady team members, regardless of role. They ensure that every employee contributes to safe, high-quality care, positive patient experience, and a collaborative work environment.

1. Patient-Centered Care – Demonstrates a commitment to delivering safe, compassionate, and high-quality care that prioritizes the well-being and satisfaction of patients and their families.
2. Integrity & Accountability – Acts ethically, maintains confidentiality, and accepts responsibility for actions, decisions, and outcomes.
3. Collaboration & Teamwork – Builds positive relationships, works effectively across departments, and supports colleagues to achieve shared goals.
4. Communication – Communicates clearly, respectfully, and effectively with patients, families, colleagues, and leadership.
5. Respect & Inclusion – Creates an inclusive environment by valuing diversity, treating others with dignity, and ensuring equitable care and opportunities for all.
6. Quality & Safety – Adheres to best practices, regulatory standards, and policies to ensure safe, reliable, and high-quality outcomes.
7. Adaptability & Resilience – Responds effectively to change, remains flexible in dynamic situations, and demonstrates resilience under pressure.
8. Continuous Improvement – Seeks opportunities to improve processes, skills, and outcomes through innovation, learning, and feedback.
9. Leadership & Professionalism – Inspires, guides, and develops individuals and teams while modeling professionalism, fairness, and transparency.
10. Employee Experience Focus – Champions a supportive and engaging employee journey that enables staff to thrive and, in turn, deliver exceptional patient care.

Grady Total Rewards
At Grady, we believe in supporting the health, well-being, and growth of every team member. Our Total Rewards package is designed to provide competitive pay and comprehensive benefits that make a difference in your life and career, including:

• Health & Wellness: Medical, dental, vision, and prescription drug coverage.

• Financial Security: Retirement savings plans with employer contributions, life insurance, and disability coverage.

• Work-Life Balance: Paid time off, holidays, and family leave benefits.

• Career Growth: Tuition reimbursement, professional development programs, and opportunities for advancement.

• Employee Support: Employee Assistance Program (EAP), wellness initiatives, and discounts on services.

Grady’s Total Rewards are designed to ensure our employees feel valued, supported, and empowered, both at work and beyond.

Why Join Grady?
Grady Health System is more than a hospital — we are a vital part of Atlanta and the surrounding communities. For over 125 years, Grady has been committed to providing exceptional care, advancing health equity, and making a difference in the lives of those we serve. When you join Grady, you become part of a team that values excellence, compassion, innovation, and collaboration.

Here, every role matters. Whether you provide direct patient care, support our operations, or lead teams, you play an important part in fulfilling our mission. We offer opportunities to learn, grow, and build a meaningful career in an environment where your contributions are recognized and valued.

At Grady, we don’t just work,  we make an impact.

Equal Opportunity Employer Statement:
Grady Health System is proud to be an equal opportunity employer. We are committed to fostering a workforce where all employees feel valued, respected, and empowered to succeed. We prohibit discrimination and harassment of any kind based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected characteristic. 

Grady is dedicated to creating an accessible work environment and provides reasonable accommodations to qualified individuals with disabilities to ensure equitable opportunities for success.