Senior Reimbursement Specialist

 
Position: Senior Reimbursement Specialist

Job ID: 156736

Location: US-TX-Houston

Department: REVENUE CYCLE MGMT ADMIN

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

About 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 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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. You will also be responsible for monitoring and tracking managed care reimbursement and denials in order provide weekly, monthly, and yearly reports to management of trends and provide training and guidance to collectors and appeal coordinators in resolving difficult account issues and to prevent further denials.

 

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Responsibilities :

  • Creates and Maintains Denial and Underpayment Databases to ensures that all denied and underpaid accounts are identified and trended in order to improve collections and reduce denials
  • Utilizes the TSI system to generate reports to monitor the underpayment activity by payors and to assist the collectors with recovery efforts on difficult underpaid accounts
  • Assists Patient Account Managers with training of in resolving reimbursement issues related to managed care and other discounted accounts
  • Upon execution of new managed care contracts or renewals of managed care contracts, assures 100% of the time that appropriate Business Services departments are notified, and applicable tools and reference items are updated and distributed in a timely fashion
  • Provides weekly, monthly, annual reports on underpayment recoveries to the Assistant Director of Contract Compliance and Collections
  • Provides period audits on accounts by Payer to ensure that accounts are reimbursed appropriately, and contractual discounts are recorded accurately
  • 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 required
  • 7 years work experience in accounting, contracting, collections, provider relations, or patient access area required
  • A bachelor’s degree may substitute for four years of the required experience


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