Accounts Receivable Representative II- Physician Billing
Job Ref # 32065
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Location: Houston, TX
Category: Professional
Job Type: Full-Time

Work Shift: DAY

Work Week: M - F


Job Summary

The Accounts Receivable (AR) Representative II is responsible for processing all third party primary and secondary insurance claims for professional services. The Representative is required to perform heavy collections and account follow-up on all outstanding balances.

ICARE VALUES

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

People 15%
- Collaborates with management to reduce aging of accounts by providing verbal and written communication
- Identifies claims processing issues and notify Supervisor and/or Manager to avoid further delay in claims processing
- Supports coverage plans as directed by the Supervisor and/or Manager (vacation, leave of absence, etc.)

Finance 35%
- Expedites and maximizes payment of insurance medical claims by contacting third party payors and patients
- Resolves edits related to billing within established Epic® charge review and claim edit work queues to ensure claims are billed appropriately and timely
- Enters professional charges into Epic® and any associated actions to perform charge capture.  Ensures completeness and accuracy of billing data (ICD-9, CPT, modifiers, etc.) when necessary

Quality/Safety 10%
- Review third party payor work queues to locate and resolve accounts
- Resolve denials as they appear
- Exceeds established follow-up productivity goals
- Documents 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 proofreading and monitoring work output
- Identifies, analyzes and escalates trends impacting AR collections

Service 20%
- Completes special projects to improve team performance, as assigned
- Demonstrates expertise of all payors, including Medicare, Medicaid and commercial payors, and applicable department's revenue cycle operations
- Ensures protection of private health and personal information. Adheres to all HIPAA and PCI compliance regulations.

Growth/Innovation 10%
- Participates in educational activities and attends team meetings
- 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

EDUCATION REQUIREMENTS

High School or GED. Associates degree preferred.

EXPERIENCE REQUIREMENTS

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

CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED

None

SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

- Knowledge of Epic® or professional and hospital system billing software related to registration, charge entry/billing and payment posting preferred.
- Strong communication (verbal and written), organizational, problem solving and team player skills.
- Ability to multi-task in a fast paced 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.
- Strong and telephone and computer skills.
- Ability to establish and maintain effective working relationships with employees and third party payors
- Ability to work in a collaborative, team environment
- Knowledge of medical billing and collection practices.
- Knowledge of insurance requirements for physician visits and procedures.
- Ability to be well organized, detail-oriented, and meet department deadlines in a fast paced environment
- Ability to analyze, identify and articulate identified trends and report trends succinctly in a clear and concise manner
- Ability to think critically and identify the global impact across the revenue cycle with a solution oriented approach

WORKING ENVIRONMENT

Professional Office Environment


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.



Company Profile

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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