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Administrative Asst II Reimbursement Officer
5 months ago
Administrative Asst II Reimbursement Officer
Come work in an environment where we truly value and respect those we serve and believe in the mission that all people can achieve a higher level of wellness and independence.
The state supported living centers serve people with intellectual and developmental disabilities who are medically fragile or who have behavioral problems. The centers provide campus-based direct services and supports at 13 centers located throughout the state.
The state of Texas offers many benefits to employees. HHSC is a qualifying organization for the Federal Public Service Loan Forgiveness Program, which forgives the remaining balance on college student Direct Loans after making qualifying monthly payments. We also offer excellent health benefits, a lifetime monthly retirement annuityas well as (k) and Programs under the Employees Retirement System of Texas.
If you are looking for a place to work where you can establish a career that is filled with purpose, this is the job for you
Administrative Asst II Reimbursement Officer I Performs advanced technical work in pursuit of reimbursement for services provided to individuals at HHSC State Supported Living Center facilities. As delegated by the Reimbursement Manager, work involves obtaining financial information, establishing and maintaining accounts receivable in automated data system and processing claims against third party sources; and frequent contact with the public in person, correspondence, and by telephone. Also performs clerical work in areas such as bookkeeping, statistics, and may perform diagnostic coding. Abides by all Denton SSLC policies and procedures as well as maintains an effective, harmonious relationship with all staff, families, and residents. Works under the general supervision of and work is subject to review by the Reimbursement Manager.
Essential Job Functions:
Attends work on a regular basis and may be required to work a specific shift schedule or, at times, even a rotating schedule, extended shift and/or overtime in accordance with agency leave policy and performs other duties as assigned.
Performs various activities necessary to collect Medicaid under the ICF-IDD program; calculates billing rates; maintains accounts in automated system; monitors and reports changes in individuals’ income, and resources; adjusts budgets; resolves problems related to Medicaid eligibility of individuals. Performs various activities necessary to collect Medicare Part B reimbursement for physician services; prepares, distributes, and tracks service documentation sheets; gathers medical service data; submits physician applications for enrollment; maintains price listing and coding information; compiles and submits claims; posts payments to accounts in automated mainframe system; maintains reports of claims and collection data; researches denials and discrepancies; submits medical records as requested to the carrier. Establishes and maintains accounts receivables and enters financial transactions into the automated data system. Answers inquiries on individual accounts as requested by payers. Performs various activities necessary to collect reimbursement from other 3rd party payers and individuals; contacts appropriate agencies to confirm eligibility for Medicare, Medicaid, Champus, insurance, VA, etc.; completes and submits applications, forms, and paper claims for reimbursement, including medical records as required; coordinates claim submission when multiple third-party sources exist; sends form letters regarding payments and delinquent accounts and posts payments to mainframe accounts receivable system. Researches denials and takes appropriate action. Refers accounts requiring further collection work or additional information promptly to the Reimbursement Manager. Identifies, completes, or arranges application process for benefits from Social Security Income programs on behalf of individuals with potential eligibility. Performs office functions, including maintenance of files, distribution of daily mail, answering telephone, greeting visitors, word-processing, and photocopying documents. Reconciles with cashier, trust fund clerk, and accounting, monthly cash receipts for both third-party and non third-party collections for proper crediting of individual accounts. As needed, provides to facility staff information pertaining to individuals’ financial status, 3rd party coverage of medical services obtained off-campus, and benefits under Social Security, Supplemental Security Income, Veterans Administration, etc. Completes intake of financial information at time of client’s admission and during follow-up reviews to assess for possible sources of reimbursement; conducts interviews; reviews records such as social histories, staff summaries, etc.; contacts knowledgeable sources for needed information; documents information on standard forms; analyzes information for ability to pay. Assists Reimbursement Manager with obtaining and compiling information and completing forms to refer accounts
Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location. Knowledge Skills Abilities:
Knowledge of health-related accounting and collection procedures and use of automated data process in such procedures. General office procedures and rules and regulations governing reimbursement for agency services.
The position requires adherence to all applicable laws, regulations, policies, procedures and /or guidelines of HHSC and Denton State Supported Living Center. Interpersonal skills and relationships with supervisors, co-workers, and persons serviced will be conducted in a manner conducive to facilitating cooperation and harmony in the work environment and to assure achievement of the agency’s mission. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
