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CHW Revenue Cycle Management Billing Specialist
2 months ago
Coastal Health & Wellness is Galveston County’s Community Health Center, with clinics in Texas City and Galveston. We also service TCISD students and employees. First established in 1970 and then called Galveston County Coordinated Community Clinics (4C’s), we provide high quality healthcare to all - offering primary care, prenatal, dental, and behavioral health counseling services.
RCM provides task-based coding, billing, and collection support to CHW and various Galveston County Health District (GCHD) partners. This includes standard, highly reliable, team-oriented, daily work with payors including Medicare, Medicaid, Medicaid Managed Care, Commercial Insurance as well as County Indigent and Self-pay patients in NextGen EPM/EHR/EDR.
The CHW Revenue Cycle Management Billing Specialist is a core contributor to the health & integrity of CHW’s revenue cycle performance. This team member is responsible for compliant, comprehensive, and critical work in areas including but not limited to medical, dental and/or behavioral health pre-authorization, eligibility & benefits, claims submission, A/R follow-up, payment posting & reconciliation, denial management and customer service.
We can offer you:
- Excellent Benefits; including an Amazing retirement package, Paid Time Off plans, Affordable Medical Insurance, FREE Life Insurance, FREE Long-Term Disability, FREE Parking and much more
- Team Oriented Environment
- Hourly Rate: $20.00 - $22.00
We want you to join our team of professionals If you meet the criteria listed below, please apply.
Required:
- Graduation from an accredited high school or equivalent.
- 2+ years of experience in a medical, dental and/or behavioral health care practice performing task-based billing functions in an EPM system (as summarized above). NextGen EPM & FQHC experience preferred.
- Strong team player who intentionally invests in the development of others and identifies/closes knowledge gaps.
- Capable and competent time management, multi-tasking acumen
- Excellent written & interpersonal skills.
- Bilingual in Spanish preferred.
- Understanding of medical terminology and coding & billing compliance laws, regulations, policies, and guidelines.
- Customer experience-oriented professional with demonstrated performance history and commitment.
- Advanced skills Microsoft suite of products; Outlook, MS Office (MS Excel & MS Word) – SharePoint experience a plus.
- Must be compliant with GCHD Immunizations policy and ICS training requirements.
- Must pass criminal background check and drug/alcohol screening.
- Must be willing and able to work evening and weekend hours, as necessary.
An equivalent combination of education and work experience which appropriately demonstrates the knowledge, skills and abilities to perform the above described essential functions will be considered when hiring for this role.
Traditional Duties:
- Charge and payment entry within NextGen Electronic Practice Management (EPM) system. Coordinates and clarifies with providers, when necessary, on missing or incomplete documentation,
- Correct, submit, and follow-up on unpaid medical, dental, and behavioral health claims with all payors including Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies,
- Analyze and interpret claim reimbursement and patient account and claim-level transactions,
- Process appeals online or via paper submission as prescribed by payor policies,
- Reconcile bank deposit, ERAs and patient collections,
- Post payments and contractual adjustments accurately based on explanation of benefits (EOBs) from payors,
- Assist with billing audit related requests,
- Process payment transfers and refunds to payors, State of Texas, patients and/or guarantors,
- Attend all staff in-services, provider meetings, workshops, and training, lead as appropriate,
- Communicate with cross-functional, internal & external teams to identify & resolve billing and/or payment issues,
- Answer/respond to incoming calls, portal inquiries, askRCM, NextGen tasks, emails and other correspondence related to patient accounts by deploying active listening. Answers patient questions on patient responsible portions, co-pays, deductibles, write-offs, etc.
- Communicate daily with internal and external customers via phone calls, EPM/EHR tasks and written communication,
- Identify trends, and payor issues related to billing and reimbursement; report and/or escalate to RCM management,
- Research, document findings, and communicate professionally, respectfully, and effectively with all stakeholders,
- Maintain patient confidentiality and protect GCHD/CHW operations by keeping patient information confidential,
- Prepares and ensures accuracy of all reports to management, consultants, payors, and other 3rd parties, as appropriate,
- Acts as a back-up to other RCM team members and actively participates in RCM projects & blitzes,
- Exercise independent judgment based on CHW Policy and compliant billing best practice,
- Perform other duties as assigned by management.
No Phone Calls Please
ADA/EEO/DFWP
Our Mission: Protecting and Promoting the One Health of Galveston County
