Billing and Collections Spec II RMF Denials Management

Billing and Collections Spec II - FT
- Days - RMF Denials Management - 21988

US:

TX:

Edinburg | HEALTH INFORMATION MANAGEMENT | Full Time

Posted 2 days ago

DHR Health - US:

TX:

Edinburg
- Days

Summary:

MISSION STATEMENT:

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

VISION:

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.

POSITION SUMMARY:

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 appeals 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.

POSITION EDUCATION/

QUALIFICATIONS:

• High School Diploma/GED required
• 2-3 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 advices, 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
• JOB KNOWLEDGE/
  
  EXPERIENCE:
  
  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.

Responsibilities:

Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, 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…