Houston Methodist

Houston Methodist.

  • Houston, TX


  • Irreversible.

  • Full-time.

Notes –

  • This position is hybrid (Remote and Onsite).
  • This position lies at our St. Catherine school situated at: 701 S. Fry Rd. Katy, TX 77450

JOB SUMMARY

The Medicare Specialist (MS) is accountable for the billing and follow up of Medicare balance dues. The MS is thought about a specialist in Medicare billing standards. This consists of preparing and processing claims; cleaning billing modifies; claim recognition and submittal; and receivable follow up to make sure that claims are paid prompt, precisely, and compliantly. The MS will guarantee that all claims billed are problem with state and federal guidelines associated with the Medicare program, and all payments gotten by the Medicare program are appropriate. These abilities are essential in order to make sure any claim that leaves Methodist is certified.

The MS should have a strong working understanding of client balance due. In addition to billing Medicare standards, this consists of understanding of Patient Access Services/Admissions, Case Management, Medical Records Coding, Collections, Charge Review, Medicare payer systems (FSS), and post payment activities.

The MS should have skilled understanding of the Medicare program; have the capability to partner with numerous medical facility department equivalents, and the capability to interact verbally and in composing.

The MS will follow basic policy and treatments (i.e., Attendance, Dress Code, Call in Procedures, Levels of Authority, and so on) and need to want to accept feedback from Management in a favorable way and carry out enhancements where shown.

The MSII will be anticipated to communicate with all the Corporate Business Office (CBO) sub-units and other medical facility service locations daily. The MS will be anticipated to cultivate excellent service relationships to promote consistency and reliable interaction to fix client and billing issues post care.

DUTIES AND RESPONSIBILITIES

PEOPLE 15% Is well-informed about operations and efficiently interacts in composing or orally with clients, suppliers, coworkers, and management to satisfy functional organization requirements. (EF)

  • Communication is active, favorable, and reliable.
  • Participates in action strategies to fulfill department objectives.
  • Demonstrates SERVICE PRIDE requirements.
  • Demonstrates and supports the Methodist vision, objective and ICARE worths declaration.
  • Attends department and sub-unit conferences. This consists of preparing ahead of time and active reporting of problems as required to management. (EF)
  • Partners with department suppliers as required to guarantee claims are certified and WIP is at department requirements.
  • Partners with healthcare facility department equivalents to fix claim problems.

FINANCE 10% Follows levels of authority for publishing changes, refunds, and legal allowances. Posts changes precisely as specified on the Medicare RA or835 (EF)

  • Has working understanding of the Medicare Electronic Data Interchange (EDI) procedure consisting of 837 development and submittal, Medicare Shared System processing and status areas, transmittal balancing, and 835 processing.
  • Manages time successfully to report to work as arranged; to satisfy quality and performance requirements; and to satisfy task due dates

QUALITY/SAFETY 25% Understands and totally uses computer system systems utilized in the technological stream of sending Medicare claims. Consists of however not restricted to: (EF)

  • ADT and Patient Accounting systems (HBOC/Epic, and so on)
  • Billing Software/Scrubbers (Claims Administrator, Claims Master, and so on)
  • Medical Necessity Software (PCA, and so on)
  • Medicare FISS (Medicare Manager/FISS)
  • Receivable follow up software application (Receivables Work Station, Aeos, Epic, and so on)
  • Imaging Software (HPF, and so on)
  • Understands Medicare IPPS and OPPS consisting of SNF, Psych, and Rehab payment methods, to make sure claims are certified. This consists of comprehending the nature and resolution of claim modifies such as CCI/NCCI, APC, and LCD/NCD. (EF)
  • Fully makes use of system claim tools consisting of main and secondary claim scrubbers, claim modifying software application post preliminary costs, receivable software application, and the Medicare shared system (FISS) to make sure all WIP is kept at department requirements. (EF)
  • Must have the ability to completely comprehend the Medicare remittance suggestions (RA) and all monetary aspects consisted of on the RA along with the description of advantages (EOB) from other insurance coverages. (EF)
  • Ability to record accounts in a short and succinct way, showing resolution or actions required for resolution. Recorded remarks need to be totally comprehended by the next individual who evaluates the account. (EF)
  • Exceed quality requirements based upon account evaluations and feedback as supplied by the Government Manager. This consists of including instruction/training into everyday regimens on an instant basis. (EF)
  • Understands Medicare payment categories consisting of however not restricted to MS-DRGs, Outliers, APCs, Pass Through, and RUGs. Furthermore, should comprehend the claim requirements associated with payment such as occurrence/condition/value codes, ABNs, Modifiers, Transfers, Exhausted Benefits, Medicare as a Secondary Payer, and Credit Balances. (EF)
  • Demonstrates understanding of everyday jobs in how they affect department metrics consisting of WIP, Cash, Credit Balances, and Agings. (EF)

SERVICE 25% Demonstrates a working understanding of ICD coding (treatment and medical diagnoses), CPT and HCPCS. (EF)

  • Understands the Revenue Cycle (from a tactical viewpoint).
  • Meets weekly efficiency requirements consisting of keeping individual WIP at department (EF)
  • Responds to other departements when Medicare claim processing details is required. This can consist of dealing with management to react to internal audit, case management, Medical Records, and so on (EF)
  • Responds properly, completely and prompt to client associated concerns and/or concerns. This can be demands from client service call center, client correspondence, or client demands stemming from other medical facility departments or management. (EF)

GROWTH/INNOVATION 25% Independently uses offered resources (electronic and print) to get understanding of Medicare procedure and modifies in order to fix billing concerns and operate in development (WIP): MAC site, UB04 Claim Editor, Medicare I/OCE editor, CMS site, and so on (EF)

  • Uses academic tools to remain existing with the Medicare Program. This consists of going to regional workshops, personnel trainings, CMS webinars, notifies, notifications, bootcamp, and so on
  • Participate in Claim and Software screening as required for Software Updates, Business Profile updates or IT updates.

This position description is not meant to be all inclusive, and the staff member will likewise carry out other fairly associated service tasks as appointed by the instant manager and other management as needed. The Houston Methodist Hospital books the right to modify or alter task tasks and obligations as the requirement develops.

EDUCATION REQUIREMENTS

High School Diploma or GED needed. Some college or Associates a plus. Bachelor’s in health care associated field will be offered choice.

EXPERIENCE REQUIREMENTS

Prior Medicare billing (claim generation and modify resolution) experience in a big health center or business setting needed (minimum 5 years)

Medicare receivable follow up making use of client database (HBOC or EPIC) experience (3 years minimum).

Houston Methodist.

  • Apply Now.