*5 + years of hospital billing and insurance follow up experience is required

*Knowledge of Texas Medicaid

*Epic experience is preferred

*Hybrid position-location: 701 S Fry Rd 77450 (Katy)

At Houston Methodist, the Accounts Receivable Specialist position is responsible for billing and follow up of insurance or institutional accounts receivable and is considered an expert in billing and collection guidelines for insurance or institutional accounts. Duties include preparing and processing claims, clearing billing edits, claim validation and submittal, and receivable follow up (e.g. collections, payment review, denials management), and where applicable transfer of charges, record maintenance, ensuring accurate registration, and maintaining applicable documentation. This position ensures that all claims billed to the insurance or client are compliant with state and federal regulations, grant provisions or provider agreements, and all payments received are timely and correct. The Accounts Receivable Specialist interacts with all Central Business Office (CBO) sub-units and other hospital service areas daily and cultivates good business relationships to promote harmony and effective communication to resolve patient and billing concerns post care.

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.

• Practices the Caring and Serving Model

• 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 collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Displays cultural humility, diversity, equity and inclusion principles

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

PEOPLE ESSENTIAL FUNCTIONS

• Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal department and organizational results

• Collaborates with other departments and/or vendors as needed to ensure claims are billed and resolved compliantly and timely

• Strikes a balance between maintaining trustful relationships and ensuring timely account resolution. Exhibits professionalism and trustworthiness

SERVICE ESSENTIAL FUNCTIONS

• Responds appropriately, thoroughly and timely to customer requests, questions, or referrals

• Reviews incoming correspondence and takes appropriate action. Responds promptly to payor's request for additional information/documentation

• Informs manager of payor trends or any problems or changes in payor requirements, including any barriers or obstacles

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Meets or exceeds stated departmental standards for Key Performance Indicators (KPI) (e.g., inventory management, productivity, quality reviews, agings, etc.)

• Fully utilizes available technology to submit claims or client invoices timely, accurately, and compliantly

• Provides clear and concise documentation of every action taken on an account in the system notes. Provides balance detail to clearly identify account resolution and next responsible party or next steps to resolution as needed

FINANCE ESSENTIAL FUNCTIONS

• Accurately and compliantly resolves insurance or institutional balance after payment or adjudication, and correctly identifies any patient liability (i.e., contractual/payment review, etc.) and ensures accurate resolution of account to payment or client terms

• Works receivable inventory within department standards including, as applicable: maintaining list of institutional accounts; documenting agreement arrangements or reasons for outstanding balances; performs collection efforts; establishing or correcting new client or patient accounts; coordinating and/or posting adjustments, contractual allowances, or refunds within levels of authority; submitting appeals on denied claims to ensure appropriate reimbursement as needed.

• Where applicable and as prompted by management, provides status of the outstanding receivables or inventory including outstanding balances, charging practices and payment or payer trends, and any barriers or obstacles to payment

• Uses resources effectively and efficiently. Organizes time effectively, minimizing incidental overtime, and sets priorities. Utilizes time between heavy workloads efficiently and helps other team members

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Stays current on collection procedures related to various payors, industry trends or client agreement terms. Actively engages in personal assessment and expands learning beyond baseline competencies with a focus on continual development (i.e., participates in training opportunities, focal point review activity, etc.). Applies new learning

• Generates and communicates new ideas and suggestions that will improve quality or service

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.

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

• Some college education preferred

WORK EXPERIENCE

• Five years of experience in hospital billing and insurance follow up, preferably in a large volume setting

LICENSES AND CERTIFICATIONS - REQUIRED

• N/A

LICENSES AND CERTIFICATIONS - PREFERRED

• Certified Revenue Cycle Specialist (CRCS) or Certified Patient Account Technician (CPAT) through the American Association of Health Care Administrative Management (AAHAM), or other hospital billing certification such as EPIC)

KNOWLEDGE, SKILLS, AND ABILITIES

• 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

• Extensive knowledge of claims reimbursement and insurance collection practices (for Managed Care, Medicare/Medicaid, Workers Comp, etc.); knowledge of how to interpret payor contracts, guidelines, and/or requirements

• Extensive knowledge of billing, collections, reimbursement, contractual agreements and the appeals process

• Ability to follow-through and handle multiple tasks simultaneously

• Excellent communication and negotiation skills, as well as an ability to work independently and interdependently with other business office staff

• Good judgment in account resolution and ability to apply a professional approach in working with patients and insurance companies

• Sharp analytical abilities in order to resolve patient/insurance accounts timely, accurately, and compliantly

• Proficient computer skills and ability to learn and navigate multiple software programs

• Knowledge of insurance account receivable and revenue cycle

• Expert knowledge of the various state and federal insurance programs

• Ability to partner with various hospital departmental counterparts

• Working knowledge of International Classification of Disease (ICD) coding (procedure and diagnoses), Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS)

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (department approved) Yes

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area No
• May require travel outside Houston Metropolitan area No

Houston Methodist (HM) is one of the nation’s leading health systems and academic medical centers.  HM consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston metropolitan area.  HM also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities.  Overall, HM employs over 25,000 employees.   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.

In 2019 Houston Methodist and its physicians treat more than 6,333 international patients from more than 76 countries. Houston Methodist Global Health Care Services’ consulting and education divisions also provide advisory services and training and development to health care organizations around the world.