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
- Maintains knowledge of Federal, State, and local billing regulations and partners with managed care contracting as needed.
- Maintains knowledge of contracts, payor plans and benefits, billing/follow up procedures
- Strong organizational and problem-solving skill as evidenced by capacity to prioritize multiple tasks and role components
- Working knowledge of Microsoft products including PowerPoint, Word, Excel, and Outlook
- Experience with clinical decision criteria such as InterQual, Milliman, etc.
- Demonstrates strong knowledge of commercial insurance and governmental programs, state and federal regulations and billing processes, managed care contracts and coordination of benefits related to coverage, clinical appeals, and denials to include knowledge of CPT and ICD codes and familiarity with Local Coverage Determination (LCD)/ National Coverage Determination (NCD)
- Competence in writing clinical appeals for medical necessity compliance or level of care for government and nongovernmental payors
- Ability to develop an appeal strategy and facilitate clinical appeals to ensure recovery
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
- Uniform No
- Scrubs No
- Business professional Yes
- Other (department approved) No
ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
TRAVEL**
**Travel specifications may vary by department**
- May require travel within the Houston Metropolitan area No
- May require travel outside Houston Metropolitan area No