Reimbursement Specialist - Healthcare jobs in Texas

The Reimbursement Specialist is responsible for gathering, tracking, verifying, and creating claims using billing software. May post payments and follow up with payer to resolve unpaid claims. This position requires interaction with all agency programs providing treatment. Position will require diligence, attention to detail and a high level of critical thinking skills. Basic knowledge of ICD-10, CPT and HCPCS Codes.

Required Education and Work Experience

· Associate or Bachelor Degree in Business or Billing Coding Certification

· A minimum of 1-3 years of previous billing experience.

· Any combination of education and experience that can be demonstrated to be applicable to the duties listed in the job description.

· TCM Experience Preferred

Essential Functions

1. Verify that all transactions comply with the Organization's financial policies and procedures as well as Employee Handbook and HIPAA policies and procedures.

2. Assures that all services rendered are billed correctly by verifying against sign in sheets and documentation on electronic health record.

3. Will create claims using the billing software, payer website or paper claims.

4. Follow up on client accounts to determine the amount due from Medicaid, Medicare and other Third Party Payers. Assure that all claims are processed and reimbursement is appropriate.

5. Keep accurate accounting of claims filed, payments received and appeals. Process appeals with correct information to appropriate payer and verify payments are received

6. Identify correct payer, determine the amount due from the payer and make contact with the payer when necessary with established department procedure and legal constraints.

7. May assist programs with verifying insurance coverage and coordinate assignment of benefits

8. Tracks authorization number and services allowed. Keeps account of remaining units and will alert program staff when new authorization is required.

9. Stay informed on any payer updates that will impact the billing process by attending trainings and reading payer websites.

10. Reply to inquiries regarding billing and census in a timely manner.

11. Demonstrate initiative to improve quality of work.

12. Balance responsibilities; be open and objective to other’s views; give and welcome feedback; contribute to positive team goals; and put the success of the agency above own interest.

13. Perform other duties as requested by Financial Services Director.

Additional Eligibility Qualifications

· Ability to effectively communicate verbally and in writing with staff and with external customers such as federal, state, and local agencies, and prepare and make presentations.

· Must be able to demonstrate effective interpersonal skills; being tactful, courteous, and diplomatic with internal and external contacts.

· Must have experience with Microsoft Office tools such as Word, Excel, and Adobe applications

· Must have ability to make independent decisions that are generally guided by established procedures.

· Must have a desire to learn ethical and compliant business practices.

· Must be able to handle sensitive, stressful and confidential situations and account information.

· Analytical, organizational, oral and written skills are necessary.

· Ability to make responsible decisions based upon integrity.

· Must be able to support, interpret, implement, and communicate State and Federal policies, procedures, laws, rules, and regulations for various departments.

· Willingness and ability to learn new tasks.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. This position requires the ability to move throughout the community and occasionally lift office products and supplies, up to 20 pounds.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Job Type: Full-time

Pay: From $15.00 per hour

Benefits:

• 401(k) matching
• Paid time off

Work setting:

• Hybrid work

Work Location: Hybrid remote in El Paso, TX 79902