Billing and Collections Specialist, RMF Denials Management

Billing and Collections Specialist, RMF Denials Management - 21293

US:

TX:

Edinburg | Financial Services | Full Time

Posted 3 weeks ago

DHR Health - US:

TX:

Edinburg - Days

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

The Billing and Collections Specialist in the RMF Denials Management department is responsible for conducting quality assurance reviews on denied claims. When an appeal is necessary, the specialist drafts the appeal to payers using relevant clinical indicators, official coding guidelines, and documentation from the patient’s medical record. Basic knowledge of medical terminology, CPT/HCPCS codes and ICD
10 codes. Additionally, the specialist plays a crucial role in reporting quality results, tracking and identifying educational opportunities within the Revenue Cycle departments, addressing client subject matter needs, and contributing to educational support and training efforts.

• High School Diploma/GED is required
  0-2 years of experience in denial management, utilization review or prior authorization in a hospital, provider, or healthcare system.
  Experience in healthcare billing and reimbursement
  
  Experience with EMR system workflows
  Strong knowledge of health care services reimbursement methodologies
  Knowledge of claim forms and remittance advice, including coding and billing practices
  Ability to interpret contract language
  Working knowledge of medical terminology
  Knowledge of Microsoft Office Suite
  Excellent Customer Service
  Bilingual
  - English/Spanish, preferred
  Previous healthcare and hospital/professional experience preferred.
  Ability to use the internet to obtain information from Third Party Payers or other sources is required.
  Requires working with minimal to moderate interruptions

Previous healthcare and hospital/professional experience preferred.
Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties

Establishes and maintains long-term customer relationships, building rapport with other department staff

Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.

Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.

Medical Terminology, ICD – 10, Codes, CPT Codes, HCPCS code, Modifier knowledge required.

Ability to use the internet to obtain information from Third Party Payers or other sources is required.

Requires working with minimal to moderate interruptions

Occasional evening or weekend work may be required

Promote Facility Mission:
Advocate for the facility’s mission, vision, and values by effectively communicating them and incorporating them into service development, standards, and practices.
Denials and Appeals Proficiency:
Demonstrate expertise in handling denials and appeals.
Create Appeal Letters:
Draft detailed appeal letters with all necessary information.
Follow‑Up on Insurance Accounts:
Manage and follow up on assigned insurance accounts
Adhere to Billing Guidelines:
Follow governmental billing and collection rules as outlined in Medicare/Medicaid manuals when interacting with insurance carriers.
Software Proficiency:
Utilize different software systems to verify eligibility and claim status
Billing and…