RCM Specialist V - MSO Outsourced
Company: Legacy Community Health Services
Posted on: January 16, 2022
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
- 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
- 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
- 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
- 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
- Communicates with Leads to identify and resolve all RCM
- 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
- Minimum of 2 years related experience and training with
insurance billing/collections and denial management preferred
- EPIC Certification preferredBenefits9 Holiday + 1 Floating
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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