Houston Methodist
Revenue Cycle Specialist - Plastics (Medical Center)
Houston Methodist, Houston, Texas, United States, 77246
Overview
Join to apply for the
Revenue Cycle Specialist - Plastics (Medical Center)
role at
Houston Methodist . At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. This role ensures timely coordination and completion of regulatory and/or revenue-enhancing special projects identified by the Revenue Cycle Managers. The Specialist is responsible for resolving all outstanding third-party primary and secondary insurance claims for professional services, performing collections activities on complex denials, and preparing complex appeals on outstanding insurance balances in the professional fee environment. This position serves as the subject matter expert in account follow-up and provides information regarding complex denial trends for future prevention. The employee must act in accordance with all Houston Methodist policies and procedures, including Houston Methodist Experience Service Standards. This description is not intended to be all-inclusive; the employee may perform other related duties as assigned. Houston Methodist reserves the right to revise duties and responsibilities as needed. Responsibilities
Collaborates with management to target complex claims and reduce aging of accounts by providing verbal and written communication. Assists with knowledge sharing, payor and department cross-training, and supports 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 delays in payments; collaborates with internal CBO departments and Account Managers to communicate and prevent denials. Provides suggestions for resolution. Completes special projects to improve team performance, as assigned. Demonstrates expertise as the subject matter expert with all payers (Medicare, Medicaid, commercial payers) and provides coaching and support for collection-related projects. Ensures protection of private health information and complies with HIPAA and PCI regulations. Reviews third-party payer work queues for complex payers and resolves accounts; manages denials and appeals, creating and submitting appeals when necessary. Resolves denials with actionable items leading to resolution; engages the coding follow-up team for medical necessity or coding-related appeals. Ensures accounts are completed with high quality; documents clear, concise follow-up notes in the system for each account worked. Identifies, analyzes, and escalates trends impacting accounts receivable (AR) collections. Expedites and maximizes payment of insurance medical claims by contacting third-party payers and patients, including outbound calls and payer website access; assess the entire account to determine necessary resolution steps. Qualifications
Education: High School diploma or equivalent (GED, homeschool equivalency, etc.). Associate 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: Proficiency in English; customer-service oriented communication; understanding of payor policies; ability to analyze and resolve accounts; familiarity with insurance contracts, payer policies, guidelines, and appeals processes; strong judgment and professional demeanor in dealing with patients and payers. Supplemental Requirements
Work Attire
Uniform: No Scrubs: No Business professional: Yes Other (department approved): No On-Call
Note: On-call may be required during emergencies. On Call: No Travel
Travel specifications may vary by department. May require travel within the Houston Metropolitan area: No May require travel outside the Houston Metropolitan area: No Houston Methodist is an Equal Opportunity Employer. Job Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Accounting/Auditing and Finance Industries: Hospitals and Health Care Additionally, various related Revenue Cycle leadership and focused roles are listed for referral and alert purposes. We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
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Join to apply for the
Revenue Cycle Specialist - Plastics (Medical Center)
role at
Houston Methodist . At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. This role ensures timely coordination and completion of regulatory and/or revenue-enhancing special projects identified by the Revenue Cycle Managers. The Specialist is responsible for resolving all outstanding third-party primary and secondary insurance claims for professional services, performing collections activities on complex denials, and preparing complex appeals on outstanding insurance balances in the professional fee environment. This position serves as the subject matter expert in account follow-up and provides information regarding complex denial trends for future prevention. The employee must act in accordance with all Houston Methodist policies and procedures, including Houston Methodist Experience Service Standards. This description is not intended to be all-inclusive; the employee may perform other related duties as assigned. Houston Methodist reserves the right to revise duties and responsibilities as needed. Responsibilities
Collaborates with management to target complex claims and reduce aging of accounts by providing verbal and written communication. Assists with knowledge sharing, payor and department cross-training, and supports 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 delays in payments; collaborates with internal CBO departments and Account Managers to communicate and prevent denials. Provides suggestions for resolution. Completes special projects to improve team performance, as assigned. Demonstrates expertise as the subject matter expert with all payers (Medicare, Medicaid, commercial payers) and provides coaching and support for collection-related projects. Ensures protection of private health information and complies with HIPAA and PCI regulations. Reviews third-party payer work queues for complex payers and resolves accounts; manages denials and appeals, creating and submitting appeals when necessary. Resolves denials with actionable items leading to resolution; engages the coding follow-up team for medical necessity or coding-related appeals. Ensures accounts are completed with high quality; documents clear, concise follow-up notes in the system for each account worked. Identifies, analyzes, and escalates trends impacting accounts receivable (AR) collections. Expedites and maximizes payment of insurance medical claims by contacting third-party payers and patients, including outbound calls and payer website access; assess the entire account to determine necessary resolution steps. Qualifications
Education: High School diploma or equivalent (GED, homeschool equivalency, etc.). Associate 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: Proficiency in English; customer-service oriented communication; understanding of payor policies; ability to analyze and resolve accounts; familiarity with insurance contracts, payer policies, guidelines, and appeals processes; strong judgment and professional demeanor in dealing with patients and payers. Supplemental Requirements
Work Attire
Uniform: No Scrubs: No Business professional: Yes Other (department approved): No On-Call
Note: On-call may be required during emergencies. On Call: No Travel
Travel specifications may vary by department. May require travel within the Houston Metropolitan area: No May require travel outside the Houston Metropolitan area: No Houston Methodist is an Equal Opportunity Employer. Job Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Accounting/Auditing and Finance Industries: Hospitals and Health Care Additionally, various related Revenue Cycle leadership and focused roles are listed for referral and alert purposes. We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr