Job Ref: 27103
Talent Area: Other
Houston, TX 77054
Area/Department: Corp Rev Cycle - A/R
Employment Type: Regular
Job Type: Full-Time
Organization: Houston Methodist
Work Shift: DAY
Work Week: M - F
Houston Methodist (HM) is one of the nation’s leading health systems and academic medical centers. HM consists of 7 hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center and six community hospitals throughout the greater Houston metropolitan area. HM also includes a research institute, a global business division, numerous physician practices and several free standing emergency rooms and outpatient facilities. Overall, HM employs over 20,000 employees. FORBES magazine has placed Houston Methodist on its annual list of Best Employers in 2016. Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.
Performs ongoing monitoring of assigned accounts to ensure maximization of collection dollars by providing appropriate follow-up and documenting actions taken. The Commercial Collector II often times has direct contact with other Methodist Health Care System departments as well as insurance companies; therefore, this position requires a candidate whom demonstrates a positive demeanor, good verbal and written communication skills, and is professional in both appearance and approach. The employee must demonstrate strong interpersonal and persuasive abilities in order to secure accurate and timely payment from third party payors. The incumbent is responsible for ensuring that the network`s financial viability is secured at the most basic level by securing accurate and timely payments. Any errors may result in a delay or loss of reimbursement. Extensive and in depth interaction with insurance, governments entities, and clinical personnel (i.e. physicians, nurses, tech, etc.) is required. Additionally, the Commercial Collector II must remain cognizant that the relationship with the third party payor must be maintained. Candidate must be able to handle potentially stressful situations and handle multiple tasks at one time. He/she must be a positive role model for other staff members and patients by working with them to promote teamwork and cooperation. Candidate must be able to accept behavioral and technical feedback as well as integrate suggestions in effective ways. As a member of the Methodist Health Care System team, this person must comply with Methodist Health Care System and Patient Accounting policies and procedures.
DUTIES AND RESPONSIBILITIES
1. The Commercial Collector II works independently to secure payment from third party payors. He/she must exercise financial acumen in negotiating prompt pay discounts and resolving disputes related to covered services. These tasks include, but not limited to the following:
2. Contact and monitor each account assigned. Representative II Collectors may be assigned high dollar accounts, major/complicated payors, or large inventory work queues. All accounts on the worklist must be worked at least once within a 2-week period. All new patient accounts must be reviewed within 21 days from the date the claim was filed. All clean claims filed must be verified that they have been received by the payer within the filing deadline. Must work a minimum of 45 accounts per day.
3. Provide clear and concise documentation of every action taken on an account in the system collection notes.
4. Displays assertiveness in resolving accounts and takes the appropriate action. Actions may include, but are not limited to: Obtaining corrected information and requesting rebills. Responds to payor`s request for additional information/documentation within 3 days of receipt. Confers with Billers, as necessary, to obtain additional information/clarification. Co-ordinate requests for medical records. Posting account adjustments as a result of written communication from third parties (i.e. certain contractual adjustments, etc.). Provides balance breakdown to document the status, i.e., primary payor balance, secondary or credit balance, patient balance.
5. Ensure maximization of collection dollars from insurance companies in accordance with the respective contract and/or Methodist Health Care System financial arrangement.
6. Identify accounts for advanced due diligence steps or legal placement in accordance with CCMC`s Account Documentation policy and procedure.
7. Remain current on collection procedures of various payors to provide assistance for absence (vacation, etc.).
8. Inform Manager of any payer trends, problems or changes in payor requirements.
9. Follows through, in a timely manner, on all action steps requested by manager or director.
10. Exceeds stated Performance Indicator Expectations for productivity, account reviews, and agings, as demonstrated on weekly Key Performance Indicator Document.
11. Handles all internal and external customers using ICARE and Service Plus principles.
12. Demonstrates flexibility in training new associates and assisting other staff in areas outside assigned area of responsibility.
13. Contacts are defined as substantively working an individual account in accordance with CCMC`s defined work expectations detailed in the Account Documentation policy and procedure.
High School Graduate with some additional education (i.e. computer training, communication classes, etc.), college degree preferred.
5 years experience in commercial insurance follow-up. Understands payor environment, such as managed care, IPAs, 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 and appeals process. Sharp analytical abilities are required in order to resolve the hospital`s patient accounts in a timely and correct manner. Good verbal and written communication skills in the English language.
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
Certified American Association of Healthcare Administrative Management (AAHAM) Technician a plus.
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
1. Knowledge of billing and government programs preferred.
2. Utilizes Microsoft office skills.
3. Ability to follow-through and handle multiple tasks simultaneously.
4. Ability to work independently.
5. Bilingual a plus.
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 harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.
VEVRAA Federal Contractor – priority referral Protected Veterans requested.