Revenue Cycle Specialist - Plastics; Medical Center

Revenue Cycle Specialist - Plastics (Medical Center)

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At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. They coordinate and complete regulatory and/or revenue‑enhancing special projects, resolve outstanding third‑party primary and secondary insurance claims, perform collections activities on complex denials, prepare complex appeals, and serve as a subject matter expert in account follow‑up. The specialist will provide information on complex denial trends for future prevention and adhere to Houston Methodist policies and the Houston Methodist Experience Service Standards.

Non‑exempt

• High School diploma or equivalent education (e.g., GED, verification of homeschool equivalency, partial or full completion of post‑secondary education)
• Associates Degree preferred
• Minimum five years’ experience in commercial insurance follow‑up
• CRCP – Certified Revenue Cycle Professional (AAHAM) Technician (preferred)

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations
• Proficient in speaking, reading, and writing English, especially in activities impacting patient or employee safety or security
• Effective communication with patients, physicians, family members, and co‑workers with a customer service focus
• Understanding of payor plan policies and environment for government, managed care, IPAs, and TPAs
• Good judgment in handling accounts and a professional approach in dealing with patients and insurance companies
• Knowledge of insurance contractual agreements, payer policies, guidelines, and appeals process
• Strong analytical abilities to resolve patient accounts in a timely and accurate manner

• Collaborate with management to target complex claims and reduce aging of accounts, providing verbal and written communication
• Assist with knowledge sharing, training of payor and department cross‑training, and support other team members as advised by the manager or supervisor
• Identify denial trends and notify supervisor or manager to prevent future denials and delays in payments; collaborate with internal departments and account managers to communicate and prevent denials, providing suggestions for resolution
• Complete special projects to improve team performance as assigned
• Serve as subject matter expert with all payers, including Medicare, Medicaid, and commercial payers, and support projects related to collection efforts
• Ensure protection of private health and personal information; adhere to HIPAA and PCI compliance regulations
• Review third‑party payer work queues for complex payers and resolve accounts
• Manage denials and appeals efforts, creating and submitting appeals when necessary, and engaging the coding follow‑up team for any medical necessity or coding related appeals
• Document clear, concise, complete follow‑up notes in system for each account, ensuring high quality work output
• Identify, analyze, and escalated trends impacting AR collections
• Expedite and maximize payment of insurance medical claims by contacting third‑party payers and patients, making outbound calls and accessing payer websites
• Review and assess entire account to determine necessary steps to outstanding denials
• Remain current on collection procedures of various payors and specialty departments, assisting with knowledge sharing, payor and department training, and providing support to other team members

• Uniform:
  No
• Scrubs:
  No
• Business professional:
  Yes
• Other (department approved):
  No
• On call:
  No
• Travel within Houston Metropolitan area:
  No
• Travel outside Houston Metropolitan area:
  No