Job Type: Full-Time
Posted Date: March 5, 2019
Work Shift: DAY
Work Week: M - F
The Insurance Collector is responsible for resolving all outstanding their party primary and secondary insurance claims for professional services. The Insurance Collector is required to perform collections activities on simple and complex denials and on outstanding insurance balances in the professional fee environment. This role is also responsible for providing information regarding 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.
PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.
HOUSTON METHODIST EXPERIENCE EXPECTATIONS
Provide personalized care and service by consistently demonstrating our I CARE 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.
Focuses on patient/customer safety
Delivers personalized service using HM Service Standards
Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)
Intentionally rounds with patients/customers to ensure their needs are being met
Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job
PRIMARY JOB RESPONSIBILITIES
Job responsibilities labeled EF capture those duties that are essential functions of the job.
PEOPLE - 10 %
1. Collaborates with management to reduce aging of accounts by providing verbal and written communication.
2. 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. Provide suggestions for resolution.
3. Assists with knowledge sharing, payor and department corss training, and provides support to other teammembers as advised by the manager and/or supervisor.
SERVICE - 10 %
1. Completes special projects to improve team performance, as assigned.
2. Demonstrates expertise of all payors, including Medicare, Medicaid and commercial payors, and applicable department¿s revenue cycle operations.
3. Ensures protection of private health and personal information. Adheres to all HIPAA and PCI compliance regulations.
QUALITY/SAFETY - 30 %
1. Reviews third party payor work queues to locate and resolve accounts. Resolve denials as they appear. Document clear, concise and complete follow-up notes in system for each account worked. Assures accounts are completed and worked at a high level of quality by visually proffreading and monitoring work output.
2. Identifies, analyzes and escalates trends impacting AR collections.
3. Meets and/or exceeds established follow-up productivity goals.
FINANCE 40 %
1. Expedites and maximizes payment of insurance medical claims by contacting their party payors and patients. This includes making outbound calls to payers and accessing payer websites.
2. Reviews and assesses entire account to determine necessary steps or activity to resolve outstanding denials.
3. Perform appropriate billing functions, including claims resubmission to payors.
4. Create and submit appeals when necessary. Engage the coding follow-up team for any medical necessity or coding related appeals.
GROWTH/INNOVATION - 10 %
1. Participates in educational activities and attends team meetings.
2. Assists with knowledge sharing, payor and department training, and provide support to other team members as advised by the manager and/or supervisor.
This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
Three years physician billing experience required, preferably in a multi-specialty physician practice.
In depth knowledge of CPT-4, ICD-9 and HCPCS coding. Knowledge of ICD-10 preferred.
In depth knowledge of third party payer reimbursement policies and procedures
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations.
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security.
Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles.
Knowledge of EPIC or professional and hospital system billing software related to registration, charge entry/billing and payment posting preferred.
Ability to multi-task in a fast paces environment, prioritize projects and work independently with attention to detail.
Demonstrate a high level of professionalism, customer service and interpersonal skills and operate under strict confidentiality due to the significant amount of PHI.
*Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Event, etc) regardless of selection above.
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.
Houston Methodist Specialty Physician Group - As one of the nation’s leading hospitals and academic medical centers Houston Methodist has brought together some of the nation’s leading experts in multiple specialties to serve our patients. As part of Houston Methodist Specialty Physician Group (HMSPG), these specialists not only provide excellent clinical care, but are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow. This combination of clinical service, research and academics ensures patients have access to the latest in treatments and technologies while providing the best in comprehensive patient care. Established as a non-profit corporation and certified by the Texas State Board of Medical Examiners, HMSPG enables physicians to maintain autonomy with respect to their clinical practice while growing their practice within an academic environment.
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