Reimbursement Specialist, Sr

 
Position: Reimbursement Specialist, Sr

Job ID: 151906

Location: US-TX-Houston

Department: REVENUE INTEGRITY

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: Standard Shift, must occur between 7 – 6

About Texas Children's Hospital

Texas Children’s Hospital Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.   Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.   To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Summary:

We are searching for a Senior Reimbursement Specialist—someone who works well in a fast-paced setting. In this position, you will design, develop, and manage the denial and underpayment databases for Patient Accounting. Additionally, you will be responsible to help develop reporting tools that will allow for better management of AR and effectively communicate reimbursement issues and trends with contacts at the managed care organizations and internally to the Managed Care Contracting, Patient Accounts, Admissions, and Utilization Management departments.



Responsibilities :

  • Creates and maintains denial and underpayment databases to ensure that all denied and underpaid accounts are identified and trended in order to improve collections and reduce denials
  • Functions as a liaison with regard to reimbursement issues
  • Is responsible for creating weekly, monthly, annual and ad hoc reports for Business Services Leadership and VP of Finance in order to manage and monitor Accounts Receivable and Revenue Cycle
  • Participates in Quality Improvement Program
  • Develops and maintains a denial database in order to track denials. Database will be used to log reasons for denial, identify whether denial is appealed or written –off and to monitor the collection of appealed accounts
  • Assists Patient Account Managers with training of resolving reimbursement issues related to managed care and other discounted accounts. Responds to all requests within twenty-four hours of request and keeps requesting party apprised of status at all times
  • Provides weekly, monthly, annual reports on underpayment recoveries to the Assistant Director of Contract Compliance and Collections
  • Actively participates in the development and implementation of the action plans for the department in response to Business Services adoption of Continuous Quality Improvement as observed and documented by management


Qualifications:

  • High school diploma or GED
  • 7 years’ work experience in accounting, contracting, collections, provider relations, or patient access area
  • A bachelor’s degree may substitute for 4 years of the required experience
  • Experience with healthcare appeals and denials is preferred


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