FLSA STATUS

Non-exempt

QUALIFICATIONS EDUCATION

High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.) Some college education preferred

EXPERIENCE

Five years of experience in hospital billing and insurance follow up, preferably in a large volume setting

LICENSES AND CERTIFICATIONS

Preferred CRCS - Certified Revenue Cycle Specialist (AAHAM) or Certified Patient Account Technician (CPAT) through the American Association of Health Care Administrative Management (AAHAM), or other hospital billing certification such as EPIC)

SKILLS AND ABILITIES

Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles Extensive knowledge of claims reimbursement and insurance collection practices (for Managed Care, Medicare/Medicaid, Workers Comp, etc.); knowledge of how to interpret payor contracts, guidelines, and/or requirements Extensive knowledge of billing, collections, reimbursement, contractual agreements and the appeals process Ability to follow-through and handle multiple tasks simultaneously Excellent communication and negotiation skills, as well as an ability to work independently and interdependently with other business office staff Good judgment in account resolution and ability to apply a professional approach in working with patients and insurance companies Sharp analytical abilities in order to resolve patient/insurance accounts timely, accurately, and compliantly Proficient computer skills and ability to learn and navigate multiple software programs Knowledge of insurance account receivable and revenue cycle Expert knowledge of the various state and federal insurance programs Ability to partner with various hospital departmental counterparts\nWorking knowledge of International Classification of Disease (ICD) coding (procedure and diagnoses), Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS)

ESSENTIAL FUNCTIONS PEOPLE ESSENTIAL FUNCTIONS

Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal department and organizational results Collaborates with other departments and/or vendors as needed to ensure claims are billed and resolved compliantly and timely Strikes a balance between maintaining trustful relationships and ensuring timely account resolution. Exhibits professionalism and trustworthiness

SERVICE ESSENTIAL FUNCTIONS

Responds appropriately, thoroughly and timely to customer requests, questions, or referrals Reviews incoming correspondence and takes appropriate action. Responds promptly to payor's request for additional information/documentation Informs manager of payor trends or any problems or changes in payor requirements, including any barriers or obstacles

QUALITY/SAFETY ESSENTIAL FUNCTIONS

Meets or exceeds stated departmental standards for Key Performance Indicators (KPI) (e.g., inventory management, productivity, quality reviews, agings, etc.) Fully utilizes available technology to submit claims or client invoices timely, accurately, and compliantly Provides clear and concise documentation of every action taken on an account in the system notes. Provides balance detail to clearly identify account resolution and next responsible party or next steps to resolution as needed

FINANCE ESSENTIAL FUNCTIONS

Accurately and compliantly resolves insurance or institutional balance after payment or adjudication, and correctly identifies any patient liability (i.e., contractual/payment review, etc.) and ensures accurate resolution of account to payment or client terms Works receivable inventory within department standards including, as applicable: maintaining list of institutional accounts; documenting agreement arrangements or reasons for outstanding balances; performs collection efforts; establishing or correcting new client or patient accounts; coordinating and/or posting adjustments, contractual allowances, or refunds within levels of authority; submitting appeals on denied claims to ensure appropriate reimbursement as needed. Where applicable and as prompted by management, provides status of the outstanding receivables or inventory including outstanding balances, charging practices and payment or payer trends, and any barriers or obstacles to payment Uses resources effectively and efficiently. Organizes time effectively, minimizing incidental overtime, and sets priorities. Utilizes time between heavy workloads efficiently and helps other team members

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

Stays current on collection procedures related to various payors, industry trends or client agreement terms. Actively engages in personal assessment and expands learning beyond baseline competencies with a focus on continual development (i.e., participates in training opportunities, focal point review activity, etc.). Applies new learning\nGenerates and communicates new ideas and suggestions that will improve quality or service

SUPPLEMENTAL REQUIREMENTS WORK ATTIRE

Uniform:

No Scrubs:

No Business professional: Yes Other (department approved): Yes ON-CALL

Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below. On Call
No TRAVEL
Travel specifications may vary by department
May require travel within the Houston Metropolitan area No May require travel outside Houston Metropolitan area No

QUALIFICATIONS EDUCATION

EXPERIENCE

Five years of experience in hospital billing and insurance follow up, preferably in a large volume setting

LICENSES AND CERTIFICATIONS

Company Profile:

Houston Methodist is one of the nation's leading health systems and academic medical centers. The health system consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the Texas Medical Center, seven community hospitals and one long-term acute care hospital throughout the Greater Houston metropolitan area. Houston Methodist also includes a research institute; a comprehensive residency program; international patient services; freestanding comprehensive care clinics, emergency care and imaging centers; and outpatient facilities. Come lead with us! 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