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Account Receivables Payment Review Specialist I

Job Ref: 28081

Talent Area: Administrative/Clerical

Houston Methodist Hospital
Katy, TX 77450

Area/Department: Corp Rev Cycle - A/R

Employment Type: Regular

Job Type: Full-Time

Organization: Houston Methodist

Work Shift: DAY

Work Week: M - F

Company Profile

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.

Job Summary

The Payment Review Specialist I is responsible for identifying accounts with payment review opportunities, appropriately communicating with payors regarding contract compliance responsibilities and resolving reimbursement discrepancies.

Select the applicable age group(s) of primary customers/patients served by this position.

 Not applicable
 Neonate (Birth to 28 days)
 Infants/Toddlers (29 days to 18 months)
 Toddler (18 months to 3 years)
 Preschooler (3-6 years)
 School Age (6-12 years)
 Adolescence (12-18 years)
 Young Adult (19-40 Years)
 Middle Adult (40-65 Years)
 Mature Adult (65 years and older)

System and department specific ICARE values

INTEGRITY: We are honest and ethical in all we say and do.
COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
ACCOUNTABILITY: We hold ourselves accountable for all our actions.
RESPECT: We treat every individual as a person of worth, dignity, and value.
EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

Duties and Responsibilities are cross-referenced to the hospitals Pillars of Excellence and will be transferred to the Performance Evaluation.

PEOPLE  Weight 30%
1. Interacts with others in a supportive respectful manner.
2. Participates in projects, programs and action plans to meet department goals.
3. Acknowledges and respects individual and cultural differences.
4. Collaborates and shares knowledge to support the Methodist vision, mission and goals.
5. Takes initiative to assist others.

Job Specific Accountabilities:
6. Demonstrates articulate, professional, and effective verbal and written communication skills.
7. Self-manages behaviors to meet/exceed departmental and hospital expectations.

FINANCE Weight 5%
1. Utilizes department resources/supplies efficiently.
2. Identifies cost saving or revenue opportunities
3. Manages time effectively to meet established timelines.

1. Provides timely, high quality information.
2. Maintains and achieves the highest standards of quality, delivery of care and service.
3. Continuously measures and improves quality outcomes.
4. Demonstrates knowledge and behaviors related to environmental, employee, or patient safely requirements.
5. Complies with Business Practices standards for performance.

Job Specific Accountabilities:
6. Effectively manages inventory in accordance with departmental standards.
7. Reviews accounts, takes appropriate action, and documents per departmental standards. The Payment Reviewer will look at the account to determine if the insurance company paid correctly. If paid correctly, the rep will post an adjustment to clear the balance.If paid incorrectly, the rep will transfer the account to the appeals staff.
8. Follows and understands Revenue Cycle fundamentals.

1. Responds promptly to internal and external customer requests.
2. Strives to exceed patients¿ and co-workers¿ expectations.
3. Provides a caring and supportive environment for patients and guests.
4. Identifies and anticipates customer requirements, expectations and needs.
5. Demonstrates service standards (e.g. ServicePRIDE/MethodistExperience/Service Excellence)

1. Generates and communicates new ideas and suggestions that improve quality or service.
2. Demonstrates adaptability and flexibility in the face of changing demands.
3. Displays initiative to improve relative to job function.
4. Accepts feedback and changes behavior appropriately.
5. Approaches problems with an open mind and contributes to solutions.

Job Specific Accountabilities:
6. Effectively participates in meetings.
7. Participates in/leads staff education opportunities.

This position description is not intended to be all inclusive, and the employee will also perform other reasonably related business duties as assigned by the immediate supervisor and other management as required. The Houston Methodist Hospital reserves the right to revise or change job duties and responsibilities as the need arises.

High school diploma/equivalent required, Bachelors degree in Business or related field preferred.

2+ years experience working with contract compliance or related skills.


Good verbal and written communication skills in the English language

Equal Employment Opportunity

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.