Accounts Receivable Specialist

At Houston Methodist, the Accounts Receivable Specialist position is responsible for billing and follow up of insurance or institutional accounts receivable and is considered an expert in billing and collection guidelines for insurance or institutional accounts. Duties include preparing and processing claims, clearing billing edits, claim validation and submittal, and receivable follow up (e.g., collections, payment review, denials management), and, where applicable, transfer of charges, record maintenance, ensuring accurate registration, and maintaining applicable documentation.

This position ensures that all claims billed to the insurance or client are compliant with state and federal regulations, grant provisions or provider agreements, and all payments received are timely and correct. The Accounts Receivable Specialist interacts with all Central Business Office (CBO) sub-units and other hospital service areas daily and cultivates good business relationships to promote harmony and effective communication to resolve patient and billing concerns post care.

Non-exempt

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

• Five years of experience in hospital billing and insurance follow up, preferably in a large volume setting

• CRCS - Certified Revenue Cycle Specialist (AAHAM)
• Certified Patient Account Technician (CPAT) through the American Association of Health Care Administrative Management (AAHAM), or other hospital billing certification such as EPIC

• 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
• Extensive knowledge of claims reimbursement and insurance collection practices (for Managed Care, Medicare/Medicaid, Workers Comp, etc.); knowledge of how to interpret payor contracts, guidelines, and/or requirements
• Extensive knowledge of billing, collections, reimbursement, contractual agreements and the appeals process
• Ability to follow-through and handle multiple tasks simultaneously
• Excellent communication and negotiation skills, as well as an ability to work independently and interdependently with other business office staff
• Good judgment in account resolution and ability to apply a professional approach in working with patients and insurance companies
• Sharp analytical abilities in order to resolve patient/insurance accounts timely, accurately, and compliantly
• Proficient computer skills and ability to learn and navigate multiple software programs
• Knowledge of insurance account receivable and revenue cycle
• Expert knowledge of the various state and federal insurance programs
• Ability to partner with various hospital departmental counterparts
• Working knowledge of International Classification of Disease (ICD) coding (procedure and diagnoses), Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS)

• Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal department and organizational results
• Collaborates with other departments and/or vendors as needed to ensure claims are billed and resolved compliantly and timely
• Strikes a balance between maintaining trustful relationships and ensuring timely account resolution. Exhibits professionalism and trustworthiness

• Responds appropriately, thoroughly and timely to customer requests, questions, or referrals
• Reviews incoming correspondence and takes appropriate action. Responds promptly to payor’s request for additional information/documentation
• Informs manager of payor trends or any problems or changes in payor requirements, including any barriers or obstacles

• Meets or exceeds stated departmental standards for Key Performance Indicators (KPI) (e.g., inventory management, productivity, quality reviews, agings, etc.)
• Fully utilizes available technology to submit claims or client invoices timely, accurately, and compliantly
• Provides clear and concise documentation of every action taken on an account in the system notes. Provides balance detail to clearly identify account resolution and next responsible party or next steps to resolution as needed

• Accurately and compliantly resolves…