Note: Office for this position is located at our Continuing Care Hospital: 701 S. Fry Rd. Katy, TX 77450 . (Hybrid position)

　　*Medicare experience is a plus

　　*5 years of hospital billing is required

　　At Houston Methodist, the Accounts Receivable Specialist position is responsible for billing and follow up of insurance or institutional accounts receivable and is considered an expert in billing and collection guidelines for insurance or institutional accounts. Duties include preparing and processing claims, clearing billing edits, claim validation and submittal, and receivable follow up (e.g. collections, payment review, denials management), and where applicable transfer of charges, record maintenance, ensuring accurate registration, and maintaining applicable documentation. This position ensures that all claims billed to the insurance or client are compliant with state and federal regulations, grant provisions or provider agreements, and all payments received are timely and correct. The Accounts Receivable Specialist interacts with all Central Business Office (CBO) sub-units and other hospital service areas daily and cultivates good business relationships to promote harmony and effective communication to resolve patient and billing concerns post care.

　　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

　　Generates and communicates new ideas and suggestions that will improve quality or service

　　This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

　　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

　　WORK EXPERIENCE

　　Five years of experience in hospital billing and insurance follow up, preferably in a large volume settingLICENSES AND CERTIFICATIONS - REQUIRED

　　N/ALICENSES AND CERTIFICATIONS - PREFERRED

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

　　Working knowledge of International Classification of Disease (ICD) coding (procedure and diagnoses), Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS)

　　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* NoTRAVEL**

　　Travel specifications may vary by department

　　May require travel within the Houston Metropolitan area No

　　May require travel outside Houston Metropolitan area No

　　Company Profile:

　　Houston Methodist is one of the nation’s leading health systems and academic medical centers. Houston Methodist consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston area. Houston Methodist also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities. Overall, Houston Methodist employs more than 27,000 employees and is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide high quality patient care.

　　Houston Methodist is an equal opportunity employer inclusive of women, minorities, disabled persons and veterans.

　　Houston Methodist is an Equal Opportunity Employer.

　　Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.