8 Revenue Cycle Specialist - Plastics (Medical Center) Jobs in Houston, TX
Houston Methodist is Hiring a Revenue Cycle Specialist - Plastics (Medical Center) Near Houston, TX
At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. It is responsible for the timely coordination and completion of regulatory and/or revenue-enhancing special projects as identified by the Revenue Cycle Managers. In addition, the Revenue Cycle Specialist is responsible for resolving all outstanding third-party primary and secondary insurance claims for professional services. This Specialist is required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee environment. This role is also responsible servicing as the subject matter expert in account follow-up. Also is responsible for providing information regarding complex denial trends for future prevention. The individual who holds this position exemplifies the mission, vision and values and acts in accordance with all HMH and PO CBO policies and procedures, including complying with The Houston Methodist Experience Service Standards.
- 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.
- Completes special projects to improve team performance, as assigned.
- Demonstrates expertise and serves as the subject matter expert with all payers, including Medicare, Medicaid and commercial payers, and applicable department's revenue cycle operations. Provides coaching and support to projects related to collection efforts.
- Ensures protection of private health and personal information. Adheres to all HIPAA and PCI compliance regulations.
- 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.
- 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.
- 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.
- 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
- Minimum five years' experience in commercial insurance follow-up
Job Summary
Full Time
Ambulatory Healthcare Services
$67k-88k (estimate)
02/09/2023
05/26/2024
houstonmethodist.org
CYPRESS, TX
7,500 - 15,000
2010
GABRIELA NICOLA
$5B - $10B
Ambulatory Healthcare Services
