Houston Methodist
Insurance Biller - (Museum District)
Houston Methodist
Job Overview Lead the billing functions within the Centralized Business Office (CBO), including charge entry, claim edits, payor rejections, unresolved claims and financial correspondence. Supports other departments and manages communication with payor representatives and stakeholders.
Key Responsibilities
Process all billing‑related functions in the CBO, resolving charge reviews, claim edits, payor rejections, and unresolved or non‑response claims.
Maintain departmental standards for insurance claims processing, charge entry, and billing functions.
Collaborate with revenue cycle teams to follow up on missing data that may delay claims submission and payment.
Assist with knowledge sharing, payor and department training, and support other team members.
Follow established departmental workflows within the electronic health record system and appropriate work queues.
Process financial and insurance correspondence received within billing functions.
Pull explanation of benefits as requested or for secondary claims.
Complete claim edits timely and accurately, documenting clear notes for each account worked.
Identify claim processing issues, notify supervisors, and drive improvements.
Understand fundamentals of all payors, including Medicare, Medicaid, and commercial payors, and applicable revenue cycle operations.
Ensure compliance with HIPAA and PCI regulations, maintaining patient confidentiality.
Submit claims within payor deadlines, report barriers to management, and resolve basic edits, rejections, and no‑response claims.
Monitor and process all “no response” claims for timely resolution.
Substitute accurate adjustments based on billing guidelines, departmental policies, and contract requirements.
Keep current on billing guidelines and seek opportunities for continual development.
Essential Skills & Knowledge
Proficiency in insurance billing practices and electronic billing systems.
Strong understanding of ICD and CPT coding standards.
Ability to troubleshoot billing inquiries and claim issues.
Detail‑oriented with strong analytical skills.
Effective communication skills in a customer‑service focused environment.
Proficient computer skills and ability to navigate multiple software programs.
Education & Experience • High School diploma or equivalent education (e.g., GED, completed post‑secondary coursework).
• Minimum of 2 years of professional or hospital billing experience.
Licenses & Certifications • Not applicable.
Additional Requirements • Uniform: Business professional only.
• On‑call: No.
• Travel: No required.
Other Information This job description is not intended to be all‑inclusive; the employee may perform other reasonably related business duties as assigned. Houston Methodist reserves the right to revise duties and responsibilities as needed.
Houston Methodist is an Equal Opportunity Employer.
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Job Overview Lead the billing functions within the Centralized Business Office (CBO), including charge entry, claim edits, payor rejections, unresolved claims and financial correspondence. Supports other departments and manages communication with payor representatives and stakeholders.
Key Responsibilities
Process all billing‑related functions in the CBO, resolving charge reviews, claim edits, payor rejections, and unresolved or non‑response claims.
Maintain departmental standards for insurance claims processing, charge entry, and billing functions.
Collaborate with revenue cycle teams to follow up on missing data that may delay claims submission and payment.
Assist with knowledge sharing, payor and department training, and support other team members.
Follow established departmental workflows within the electronic health record system and appropriate work queues.
Process financial and insurance correspondence received within billing functions.
Pull explanation of benefits as requested or for secondary claims.
Complete claim edits timely and accurately, documenting clear notes for each account worked.
Identify claim processing issues, notify supervisors, and drive improvements.
Understand fundamentals of all payors, including Medicare, Medicaid, and commercial payors, and applicable revenue cycle operations.
Ensure compliance with HIPAA and PCI regulations, maintaining patient confidentiality.
Submit claims within payor deadlines, report barriers to management, and resolve basic edits, rejections, and no‑response claims.
Monitor and process all “no response” claims for timely resolution.
Substitute accurate adjustments based on billing guidelines, departmental policies, and contract requirements.
Keep current on billing guidelines and seek opportunities for continual development.
Essential Skills & Knowledge
Proficiency in insurance billing practices and electronic billing systems.
Strong understanding of ICD and CPT coding standards.
Ability to troubleshoot billing inquiries and claim issues.
Detail‑oriented with strong analytical skills.
Effective communication skills in a customer‑service focused environment.
Proficient computer skills and ability to navigate multiple software programs.
Education & Experience • High School diploma or equivalent education (e.g., GED, completed post‑secondary coursework).
• Minimum of 2 years of professional or hospital billing experience.
Licenses & Certifications • Not applicable.
Additional Requirements • Uniform: Business professional only.
• On‑call: No.
• Travel: No required.
Other Information This job description is not intended to be all‑inclusive; the employee may perform other reasonably related business duties as assigned. Houston Methodist reserves the right to revise duties and responsibilities as needed.
Houston Methodist is an Equal Opportunity Employer.
#J-18808-Ljbffr