Revenue Cycle Specialist - Plastics; Medical Center

At Houston Methodist, the Revenue Cycle Specialist is responsible for providing direct and indirect revenue cycle support to the Revenue Cycle Managers. It is responsible for the timely coordination and completion of regulatory and/or revenue-enhancing special projects as identified by the Revenue Cycle Managers. In addition, the Revenue Cycle Specialist is responsible for resolving all outstanding third-party primary and secondary insurance claims for professional services.

This Specialist is required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee environment. This role is also responsible servicing as the subject matter expert in account follow-up. Also is responsible for providing information regarding complex denial trends for future prevention. The individual who holds this position exemplifies the mission, vision and values and acts in accordance with all HMH and PO CBO policies and procedures, including complying with The Houston Methodist Experience Service Standards.

Non-exempt

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

• Minimum five years’ experience in commercial insurance follow-up

• CRCP - Certified Revenue Cycle Professional (AAHAM) Technician

• 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
• Understands payor plan policies and environment for government, managed care, IPAs, and TPAs
• Exercises good judgment in handling of accounts and demonstrates a professional approach in dealing with patients and insurance companies.
• Understanding of insurance contractual agreements, payer policies, guidelines and appeals process.
• Sharp analytical abilities are required in order to resolve the patient accounts in a timely and accurate manner.

• Collaborates with management to target complex claims and reduce aging of accounts by providing verbal and written communication.
• Assists with knowledge sharing, training payor and department cross training, and provides support to other team members as advised by the Manager and/or Supervisor.
• Identifies denial trends and notifies Supervisor and/or Manager to prevent future denials and further delay in payments. Collaborates with internal CBO departments and Account Managers to communicate and prevent denials. Provides suggestions for resolution.

• Completes special projects to improve team performance, as assigned.
• Demonstrates expertise and serves as the subject matter expert with all payers, including Medicare, Medicaid and commercial payers, and applicable department’s revenue cycle operations. Provides coaching and support to projects related to collection efforts.
• Ensures protection of private health and personal information. Adheres to all HIPAA and PCI compliance regulations.

• Reviews third party payer work queues for complex payers and resolve accounts.
• Manages denials and…