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RCM Specialist V - MSO Outsourced

Company: Legacy Community Health Services
Location: Houston
Posted on: January 16, 2022

Job Description:

Legacy Community Health is a premium, Federally Qualified Health Center (FQHC) that provides comprehensive care to community members regardless of their ability to pay. Our goal is to treat the entire patient while improving their overall wellness and quality of life, in addition to providing free pregnancy tests, HIV/AIDS screening. At Legacy, we empower patients to lead better lives by promoting healthy behaviors and offering resources such as literacy classes, family planning services, and nutrition and weight management information.Our roots began in 1981 as the Montrose Clinic, with specialization in HIV education, testing, and treatment. Since then, the agency has expanded to 17+ clinics in Houston, one in Baytown, two in Beaumont, and one in Deer Park with extensive services that include: Adult primary care, HIV/AIDS care, pediatrics, OB/GYN and maternity, dental, vision and behavioral health. We also service students within KIPP, Galena Park ISD and YES Prep schools. Legacy is committed to driving healthy change in our communities.Job DescriptionResponsible for timely and accurate billing and collections of Medicare, Medicaid and commercial payers. Must possess critical thinking skills and understanding of third-party payer payment methods to prepare contractual adjustments correctly based on payer contracts or government regulations. Must be able to review and interpret medical records to evaluate the validity of payer denials. Follow-up on submitted claims in accordance with payer and facility policies, research rejections and denials, document account activity, post adjustments and demonstrate proficiency with billing system to ensure all functionality is utilize for the utmost efficient processing of claims. Responsible to report billing and collection trends, problems and issues that result in delayed claim processing and denials. Responsible to maintain current on all private and government payer billing regulations and policy for denial prevention. This is a multitask position and requires the flexibility to pivot upon need of the department, provider, MSO &/or patient.Essential Functions

  • Assesses accuracy of demographic and policy information within patient accounts and updates as needed
  • Scan/photocopy patients' identification, insurance cards and correspondence as appropriate.
  • Responds to correspondence and phone calls related to patient accounts and is available to answer billing and charge related inquires by patients, staff, managed care organizations, etc. in a timely manner
  • Communicates daily with internal and external customers via phone calls and written communications.
  • Documents all communication and transactions in patient accounts accurately and completely
  • Assists in patient collections and reconciling deposit.
  • Is fully versed and able to cover and/or train in all Customer Service functions, when necessary in regards to, answering phones, payments, assisting and directing patients in all FQHC programs and entities.
  • Identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed
  • Prepares and submits clean claims to all insurance companies either electronically or by paper.
  • Researches and resolves claim holds/rejections and denials. Verifies patient benefits, eligibility and coverage as needed.
  • Follow-up with insurance carriers on underpaid and unpaid claims
  • Accurately researches and initiates correction of pertinent information for outstanding accounts receivable such as patient demographic and insurance information, relevant UB04/1500 claim form information and modifiers, and provider information as needed.
  • Draft appeal letters to insurance companies to overturn denied or underpaid claims; rebill claims as necessary including additional documentation as needed or requested
  • Accurately reports barriers to billing and claim reimbursement and escalates all open claims to their immediate supervisor when claim resolution is beyond their scope.
  • Works Independently.
  • Pursues and participates in education to remain current with changes in the Healthcare industry.
  • Maintains patient confidence and protects medical office operations by keeping patient information confidential.
  • Contributes to team effort by accomplishing related results as needed.
  • Communicates with Leads to identify and resolve all RCM issues.
  • Performs other duties as assigned.

    Education & Training Requirements
    • High School Diploma/GEDWork Experience Requirements
      • Minimum of 2 years related experience in a medical billing setting and/or experience with an Electronic Medical Record required
      • Minimum of 2 years related experience and training with insurance billing/collections and denial management preferred
      • EPIC Certification preferredBenefits9 Holiday + 1 Floating Holiday
        403b Retirement Plan
        Medical / Vision / Dental (if eligible)

Keywords: Legacy Community Health Services, Houston , RCM Specialist V - MSO Outsourced, Other , Houston, Texas

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