Medical Collections

Request ID: 16032-1
Start/End Dates: 12/4/2023 - 4/3/2024
Resource Tax Work Location: Houston, TX - CDS
Job Title: Administrative - Administrative Assistant I

Job Description: MAX BILL RATE $30.00 - Anything over this amount will be disqualified.

Job Summary: The position requires advanced knowledge of various program billing requirements as well as federal billing rules, Medicare and Medicare, and/or IDTF Billing. The Reimbursement Specialist will actively participate in internal audits and quality improvement initiatives, maintains documentation of current workflows, and assists with special projects. The reimbursement specialists will perform complex patient account follow-up activities, actively participates in quality improvement initiatives to improve accounts receivable and assists with special projects. The reimbursement specialist is also responsible for answering questions regarding team functions, and the accurate and timely processing of appeals to various pertinent payers or programs. The reimbursement specialist will also serve as the technical expert for complex workflows, providing ongoing updates and training to existing staff for their specific area of expertise. The specialist may be responsible for handling charge review edits, claim edits and preparation, insurance follow-up, denial resolution, and necessary follow-up to ensure accurate payment.

Major Responsibilities:
Maintaining a complete collection of accounts receivable for area of expertise. This includes following accounts through the revenue cycle, from charge review, claim edits, claim submission, and follow up with third party payers and patients to facilitate prompt resolution of outstanding account balances. This includes:
Resolve claim edits via claim edit work queues and/or our external billing software.
Review charges to ensure we are filing to correct guarantor (e.g., work comp, research, transplant, or personal/family)
Analyze and reconcile denied payment transactions.
Compile and file all information needed to appeal denials.
Follow federal and state regulations to ensure compliance standards are met.
Monitor timely filing requirements on claims and appeals.
Follow-up with contracted payers to secure payments on outstanding balances.
Evaluate third party payments to ensure accuracy relative to contract language (underpayment/overpayment)
Prepare specialized invoices and information as needed for each payor.
Verify patient coverage information and update registration as required.
Accurately document all actions taken to reconcile outstanding balances.
Communicate with Revenue Cycle teams, payors and others to resolve account problems; participate in meetings as needed to address any potential payor concerns.
Evaluate the payment status of outstanding third-party claims and resolve any impediments to payment by providing information such as appropriate medical records, detailed itemization of charges, information regarding other insurance benefits, and explanation of charges.
Review and validate adjustments to accounts in the insurance folder based on insurance reimbursement, coverage, contracts and services provided.
Review charges to ensure we are filing to correct guarantor (e.g., work comp vs. personal/family)
Complete work on special projects, queries and reports as assigned.
Provide general assistance with team:
Complete quality improvement and productivity activities
Answer questions regarding team functions and assist with team direction.
Assist in training staff as needed.

Customer Service Standards:
Support co-workers and engage in positive interactions.
Communicate professionally and timely with internal and external customers.
Provide helpful assistance in anticipating and responding to the needs of our clients.
Collaborate with customers in planning and decision making to result in optimal solutions.
Ability to stay calm under pressure and deal effectively with difficult people.

Qualifications
Education: High School Diploma or equivalent combination of education/work experience.
Preferred: Associate degree in Business, Finance, Health Information Management, or related field.
Work Experience: Minimum 5 years of experience in a healthcare revenue cycle or clinic operations role.
Xifin experience.
Three years of experience in a healthcare revenue cycle, specific to area of
expertise (I.e. IDTF, Trans telephonic and Electronic Monitoring Service (e.g., 24-hour ambulatory EKG monitoring, pacemaker monitoring and cardiac event detection) or client billing.
Sitting for extended periods of time will be required.
Use of hands repetitively to type, handle and operate standard office equipment will be required.
Employee will work under typical office conditions.
All employees must pass a drug test and must have valid proof of eligibility to work in the USA.

Required Skills, Knowledge, and Abilities
Advanced analytic ability
Ability to make good judgments in demanding situations.
Ability to react to frequent changes in duties and volume of work.
Effective communication skills
Ability to listen empathetically.
Ability to logically and accurately organize details.
Ability to manage multiple tasks with ease and efficiency.
Self-starter with a willingness to try new ideas.
Ability to work independently and be result oriented.
Positive, can-do attitude coupled with a sense of urgency.
Effective interpersonal skills, including the ability to promote teamwork.
Strong problem-solving skills
Ability to ensure a high level of customer satisfaction including employees,
patients, visitors, faculty, referring physicians and external stakeholders.
Ability to use various computer applications including Xifin
Excellent PC operating skills (keyboard, mouse) and use of MS Office
Broad knowledge of health care business office practices and principles
Basic math skills and knowledge of general accounting principles
Knowledge of medical and insurance terminology, CPT, ICD coding
structures, and billing forms (UB, 1500)
Maintain confidentiality of sensitive information

Preferred Qualifications
5+ Years Prior Medical Collections Experience.
Knowledge of claims processing and adjustments
Knowledge of Medicare, Medicaid, and Commercial carriers
Excellent communication and organizational skills
Ability to calculate insurance benefits and write appeal letters (using templates)
Ability to read and understand Explanation of Benefits.
Knowledge of Out of Network (Non-participating provider) Collections
Insurance verification
Knowledge of Centricity
Basic Benefit Coordination
Knowledge of Medicaid or Medicare Claim Processing regulations

Release Comments: 2 openings!

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