Accounts Receivables Payment Review Specialist I
Job Ref # 30648
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Location: Katy, TX
Category: Administrative/Clerical

Work Shift: DAY

Work Week: M - F Specialized inpatient care for those patients requiring a longer hospital stay

  • Specialized inpatient care for those patients requiring a longer hospital stay
  • Outpatient physical and speech therapy
  • State-of-the-art diagnostic imaging such as X-ray, MRI, CT
  • Women’s Center with advanced mammography

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.
PATIENT AGE GROUP SERVED
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)


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.

JOB RESPONSIBILITIES
Duties and Responsibilities are cross-referenced to the hospital¿s 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.

QUALITY/SAFETY  Weight 30%
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.

SERVICE - 10%
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)

GROWTH/INNOVATION  25%
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.


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

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


CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
None

SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
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.



Company Profile

Houston Methodist St. Catherine Hospital is the first specialty hospital in the Houston Methodist family. Located in the heart of the Katy community, the facility provides a special menu of services for both inpatient and outpatient care by team members called to serve with excellence and compassion:

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