BILLING SPECIALIST I
BILLING SPECIALIST I
Posting Number: SRGV3875
Number of Vacancies: Multiple
Location: Harlingen, Texas
Department: School of Medicine / Clinical Affairs
Scope of Job:
Facilitate the revenue cycle process following patient accounts through entire billing process from registration to charge entry to completion of payment process working within UT Health RGV EMR/Practice Management system and with contracted billing agency.
Description of Duties:
• Works closely with Revenue Cycle team, clinics, physicians, departments, and contracted billing agency to resolve issues with insurance companies regarding incorrect registration information, claims processing, coding issues, and AR payments or denials.
• Responsible for accurate and timely resolution of preparing professional billing claims and working clearinghouse edits. This includes working Missing Slips and Billholds, verifying insurances as needed, obtaining referral information and authorizations for encounters as required by payers.
• Responsible for working pre-payer rejections and denials and ensuring billing deadlines are not missed. This includes ensuring referrals and authorizations are entered/obtained by clinics for all Medicaid Managed Care plans and/or HMO plans. Educating clinic staff based on pre- payer rejections/denials as applicable.
• Provides customer service to patients by addressing their questions, concerns or complaints. Able to assist patients with questions on their patient balance, payment arrangements, or insurance inquiries. Educates patients and clinic staff on insurance policies and insurance billing/collection procedures.
• Works with physicians and clinic staff to ensure that charts are closed and signed appropriately so coding can be completed and bills can be submitted. Verifies that CPT codes and diagnosis are entered in patient billing and/or clarifies codes as needed in PM system. Assists clinic staff with CPT codes so clinic can obtain prior authorization or communicates with clinic staff to contact payers when codes are changed based on actual procedures done on patient.
• Responsible for registering patient accounts where interfaces are not in place with UT Health partners. This includes entering demographic and insurance information, verifying insurance, entering referral information and/or prior authorization, posting charges and/or payments for clinic visits and/or hospital services. Responsible to assist clinics on patient responsibilities based on Fee Schedule and/or assisting them in finding the correct CPT code to determine patient responsibility.
• Responsible for posting payments and adjustments on patient accounts. Reconciling payment/adjustment batches daily.
• Assists clinics on completing their daily deposits information and ensures their deposit batches are reconciled daily.
• Maintains working day-to-day knowledge of electronic health record (EHR) and Practice Management (PM) system.
• Follows up and thoroughly researches reason for (post) denied claims and works appeals as necessary to resolve outstanding balances. Ensures appeal deadlines with payers are not missed.
• Identifies and documents new payer denial trends and notifies supervisor for escalated follow-up.
• Performs root cause analysis and identifies edit trends timely to minimize lag delays and maximize opportunities to improve processes.
• Demonstrates good judgment in escalating root causes and edit trends to leadership to ensure timely resolution.
• Communicates effectively with the Billing Specialist II and III and Compliance Specialist to handle accurate and timely resolution of coding-related claim edits and appeals.
• Runs billing, Accounts Receivable, denials, and any other Revenue Cycle reports as requested or needed.
• Assists in month end procedures and reporting.
• Assists with managing patient and payer credit balances following established Revenue Cycle policy and procedures.
• Performs other duties as assigned.
General supervision from assigned supervisor.
Direct supervision of assigned staff.
High school diploma or equivalent.
Certified Coding Associate (CCA) preferred.
• Two (2) years of medical, hospital, or healthcare revenue cycle related experience, including thorough knowledge of registration, scheduling, pre-certification, prior authorizations, coding, claims billing, customer service, posting, collections, and/or reimbursement processes is required. or
• One (1) year of billing experience with Certified Coding Associate (CCA)
Previous scheduling, registration, billing, coding, collections, and posting experience in a multi-specialty practice, healthcare facility, or ambulatory setting.
Use of standard office equipment.
Needs to be able to successfully perform all required duties. Office Environment; some travel and weekend work is required. Must be familiar with CPT4, ICD10, HCPCs codes and use of modifiers. Ability to be flexible with assignments and multi-task as needed. Ability to demonstrate problem-solving skills in dealing with billing and collections related issues. Proficient use of computers and a working knowledge of Microsoft Office.
Excellent verbal and written communication skills are required.
Physical Capabilities: N/A
Employment Category: Full-Time
Minimum Salary: Commensurate with Experience
Posted Salary: Commensurate with Experience
Position Available Date: 06/01/2019
Grant Funded Position: No
If Yes, Provide Grant Expiration Date:
UTRGV is an Affirmative Action/Equal Opportunity Employer that strives to hire without regard to race, color, national origin, sex, age, religion, disability, sexual orientation, gender identity or expression, genetic information or veteran status. UTRGV takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.
Special Instructions to Applicants:
Human Resources will not be held responsible for redacting any confidential information from the documents you attach with your application. The confidential information includes the following:
*Date of Birth
*Social Security Number
Please make sure that you omit this information prior to submission. We are advising that Human Resources will be forwarding your application to the department as per your submission.
If you have any questions, please do not hesitate to contact us at (956)665-8880 and/or [email protected]
UTRGV is a distributed location institution and working location is subject to change based on need.
All UTRGV employees are required to have a criminal background check (CBC). Incomplete applications will not be considered.
Substitutions to the above requirements must have prior approval from the Chief Human Resources Officer.
To apply, visit https://careers.utrgv.edu/postings/20940
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