Billing and Collections Specialist, Denials Management

Job description

Billing And Collections Specialist, Denials Management

Location: US:TX:Edinburg | Financial Services | Full Time

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

Position Summary:

The Billing and Collections Specialist I is responsible for conducting quality assurance reviews on denied claims. When an appeal is necessary, the specialist drafts the appeal to payers using relevant clinical indicators, official coding guidelines, and documentation from the patient's medical record. Basic knowledge of medical terminology, CPT/HCPCS codes and ICD10 codes are required. Additionally, the specialist plays a crucial role in reporting quality results, tracking and identifying educational opportunities within the Revenue Cycle departments, addressing client subject matter needs, and contributing to educational support and training efforts.

Position Education/Qualifications:

High School Diploma/GED is required

0-2 years of experience in a healthcare setting

Experience in healthcare billing and reimbursement

Experience with EMR system workflows

Strong knowledge of health care services reimbursement methodologies

Knowledge of claim forms and remittance advice, including coding and billing practices

Ability to interpret contract language

Working knowledge of medical terminology

Knowledge of Microsoft Office Suite

Excellent Customer Service

Bilingual- English/Spanish, preferred

Previous healthcare and hospital/professional experience preferred

Ability to use the internet to obtain information from Third Party Payers or other sources is preferred

Job Knowledge/Experience:

Previous healthcare and hospital/professional experience preferred.

Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties

Establishes and maintains long-term customer relationships, building rapport with other department staff

Demonstrates proficiency in Microsoft Office applications, and good working knowledge of Excel is preferred.

Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.

Medical Terminology, ICD – 10, Codes, CPT Codes, HCPCS code, Modifier knowledge preferred.

Ability to use the internet to obtain information from Third Party Payers or other sources is preferred. Requires working with minimal to moderate interruptions

Occasional evening or weekend work may be required

Responsibilities:

Advocate for the facility's mission, vision, and values by effectively communicating them and incorporating them into service development, standards, and practices.

Demonstrate ability in handling denials and appeals.

Draft detailed appeal letters with all necessary information.

Manage and follow up on assigned insurance accounts

Follow payer billing and collection rules as outlined in payer manuals when interacting with insurance carriers.

Utilize different software systems to verify eligibility and claim status

Demonstrate proficiency in billing and following up on claims using online or billing software.

Access payer websites as needed to retrieve information.

Understand managed care contract terms to determine correct reimbursement levels.

Compare payer reimbursement to expected payments and address discrepancies with insurance carriers.

Contact patients to gather additional information for insurance purposes, if needed.

Address faxes or messages from carriers within 24 hours to ensure timely and compliant resolution of denials.

Follow up on assigned Accounts Receivable trackers or custom reports, contacting insurance carriers for payment or recoupments.

Enter appropriate notes in host system

Correspondence Response: Respond to insurance carrier correspondence in a timely manner and provide the action plan for resolution.

Identify accounts needing insurance billing and/or rebilling or appeal.

Enter and maintain appealed accounts using appropriate indicators in host system.

Notify management of any compliance concerns or incidents.

Ensure patient confidentiality is maintained in accordance with HIPAA policies and procedures.

Attend educational conference calls and complete HealthStream learning modules on time.

Maintain required productivity and quality standards and adhere to QA process requirements.

Work towards cross-training and familiarizing oneself with facility denials.

Other duties as assigned.

Lines Of Responsibilities:

1. Billing and Collections Supervisor → 2. Billing and Collections Manager → 3. Director of Revenue Cycle → 4. Chief Revenue Officer

Customer Service:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.

Age Specific:

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirement relative to his or her age.

Americans With Disabilities Act (ADA):

A. Essential Duties: Indicated by bold print within performance standards, preceding individual numbered criteria.

The following table provides physical requirements that will be associated with, but not limited to, this position:

Light/moderate lifting up to 20 lbs., from the floor to shoulder height. - Yes - Kneeling - Yes

Must be able to assist other employees with lifting more than 20 lbs. - Yes - Walking - Yes

Light/moderate carrying up to 20 lbs. - Yes - Standing/Squatting - Yes

Straight pulling - Yes - Sitting - Yes

Pulling hand over hand - Yes - Pushing - Yes

Repeated bending - Yes - Stooping/Bending - Yes

Reaching above shoulder - Yes - Climbing Stairs - Yes

Simple grasping - Yes - Climbing Ladders - No

Dual simultaneous grasping - Yes - Depth Perceptions needed - Yes

Ability to see - Yes - Identify Colors - Yes

Operating office equipment - Yes - Twisting - Yes

Operating mechanical equipment - Yes - Crawling - No

Ability to read and write - Yes - Ability to Count - Yes

Ability to hear verbal communication without aid - Yes - Operating Personal Vehicle - Yes

Ability to comprehend written/verbal communication - Yes - Other: Ability to deal with stress - Yes

OSHA Category - III

B. Working Conditions: The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

D. Aptitudes: HIGH 1 2 3 4 5 6 LOW

Intelligence: General learning ability: The ability to "catch on" or understand instructions and underlying principles. Ability to reason and make judgments. 3

Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3

Numerical: Ability to perform arithmetic operations quickly and accurately. 2

Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to "visualize" objects or two or three dimensions

Worksite address

edinburg, TX, 78540, US

Who can apply

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