Houston Methodist

Houston Methodist.

  • Houston, TX


  • Long-term.

  • Full-time.

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, properly, and compliantly. The MS will guarantee that all claims billed are grievance with state and federal policies connected to the Medicare program, and all payments gotten by the Medicare program are proper. These abilities are needed in order to make sure any claim that leaves Methodist is certified.

The MS need to 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 different 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 should want to accept feedback from Management in a favorable way and execute enhancements where suggested.

The MSII will be anticipated to communicate with all the Corporate Business Office (CBO) sub-units and other healthcare facility service locations daily. The MS will be anticipated to cultivate excellent company relationships to promote consistency and efficient 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, associates, and management to fulfill functional organization requirements. (EF)

  • Communication is active, favorable, and efficient.
  • Participates in action strategies to satisfy 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 needed to management. (EF)
  • Partners with department suppliers as required to guarantee claims are certified and WIP is at department requirements.
  • Partners with medical facility department equivalents to deal with claim problems.

FINANCE 10% Follows levels of authority for publishing changes, refunds, and legal allowances. Posts changes properly as mentioned 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 efficiently to report to work as set up; to satisfy quality and performance requirements; and to fulfill task due dates

QUALITY/SAFETY 25% Understands and completely uses computer system systems utilized in the technological stream of transferring 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 approaches, 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 uses system claim tools consisting of main and secondary claim scrubbers, claim modifying software application post preliminary expense, receivable software application, and the Medicare shared system (FISS) to guarantee all WIP is kept at department requirements. (EF)
  • Must have the ability to totally comprehend the Medicare remittance recommendations (RA) and all monetary aspects included on the RA in addition to the description of advantages (EOB) from other insurance coverages. (EF)
  • Ability to record accounts in a quick and succinct way, showing resolution or actions required for resolution. Recorded remarks must be completely comprehended by the next individual who evaluates the account. (EF)
  • Exceed quality requirements based upon account evaluations and feedback as offered by the Government Manager. This consists of integrating 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. In addition, 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 day-to-day 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 performance requirements consisting of preserving 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 problems and/or concerns. This can be demands from client service call center, client correspondence, or client demands stemming from other healthcare facility departments or management. (EF)

GROWTH/INNOVATION 25% Independently makes use of readily available resources (electronic and print) to acquire understanding of Medicare procedure and modifies in order to deal with billing problems and operate in development (WIP): MAC site, UB04 Claim Editor, Medicare I/OCE editor, CMS site, and so on (EF)

  • Uses instructional tools to remain present with the Medicare Program. This consists of participating in regional workshops, personnel trainings, CMS webinars, informs, 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 planned to be all inclusive, and the staff member will likewise carry out other fairly associated company tasks as appointed by the instant manager and other management as needed. The Houston Methodist Hospital schedules the right to modify or alter task responsibilities and duties 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 using client database (HBOC or EPIC) experience (3 years minimum).

Houston Methodist.

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