Revenue Cycle Specialist

2 weeks ago

Houston, United States Houston Methodist Specialty Physician Group Full time

**PEOPLE ESSENTIAL FUNCTIONS**
- Collaborates with management to target complex claims and reduce aging of accounts by providing verbal and written communication.
- Assists with knowledge sharing, training payor and department cross training, and provides support to other team members as advised by the Manager and/or Supervisor.
- Identifies denial trends and notifies Supervisor and/or Manager to prevent future denials and further delay in payments. Collaborates with internal CBO departments and Account Managers to communicate and prevent denials. Provides suggestions for resolution.

**SERVICE ESSENTIAL FUNCTIONS**
- Completes special projects to improve team performance, as assigned.
- Ensures protection of private health and personal information. Adheres to all HIPAA and PCI compliance regulations.

**QUALITY/SAFETY ESSENTIAL FUNCTIONS**
- Reviews third party payer work queues for complex payers and resolve accounts.
- Manages denials and appeals efforts. Creates and submits appeals when necessary.
- Resolves denials as they appear with actionable items that result in resolution. Engages the coding follow up team for any medical necessity or coding related appeals.
- Assures accounts are completed and worked at a high level of quality by visually proofreading and monitoring work output. Documents clear, concise and complete follow up notes in system for each account worked.
- Identifies, analyzes and escalates trends impacting AR collections.

**FINANCE ESSENTIAL FUNCTIONS**
- Expedites and maximizes payment of insurance medical claims by contacting third party payers and patients. This includes making outbound calls to payers and accessing payer websites.
- Reviews and assesses entire account to determine necessary steps or activity to resolve outstanding denials.

**GROWTH/INNOVATION ESSENTIAL FUNCTIONS**
- Remains current on collection procedures of various payors and specialty departments.
- Assists with knowledge sharing, payor and department training, and provide support to other team members as advised by the manager and/or supervisor.

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.)
- Assoicates Degree preferred

**WORK EXPERIENCE**
- Minimum five years' experience in commercial insurance follow-up

**LICENSES AND CERTIFICATIONS - REQUIRED**
- N/A

**LICENSES AND CERTIFICATIONS - PREFERRED**
- CRCP - Certified Revenue Cycle Professional (AAHAM) - Technician

**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
- Understands payor plan policies and environment for government, managed care, IPAs, and TPAs
- Exercises good judgment in handling of accounts and demonstrates a professional approach in dealing with patients and insurance companies.
- Understanding of insurance contractual agreements, payer policies, guidelines and appeals process.
- Sharp analytical abilities are required in order to resolve the patient accounts in a timely and accurate manner.

**SUPPLEMENTAL REQUIREMENTS**

**WORK ATTIRE**

Uniform No
- Scrubs No
- Business professional Yes
- Other (department approved) No

**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

**Company Profile**:
Houston Methodist Specialty Physician Group is an integral part of Houston Methodist’s overall strategy to become one of the nation’s leading academic medical centers. Established as a nonprofit corporation certified by the Texas State Board of Medical Examiners, the Specialty Physician Group enables physicians to maintain autonomy with respect to clinical practice while growing their practice within an academic environment.

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

**Equal Employment Opportunity**

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

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