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 professional 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 make sure that all claims billed are grievance with state and federal guidelines connected to the Medicare program, and all payments gotten by the Medicare program are right. These abilities are needed in order to guarantee 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 health center 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 engage with all the Corporate Business Office (CBO) sub-units and other health center service locations daily. The MS will be anticipated to cultivate great company relationships to promote consistency and reliable interaction to deal with client and billing issues post care.

DUTIES AND RESPONSIBILITIES

PEOPLE 15% Is well-informed about operations and efficiently interacts in composing or orally with consumers, 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 concerns as needed 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 deal with claim concerns.

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

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

QUALITY/SAFETY 25% Understands and completely 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 guarantee 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 expense, 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 totally comprehend the Medicare remittance guidance (RA) and all monetary components 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, suggesting 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 including instruction/training into day-to-day 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, need to 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 performance requirements consisting of keeping individual WIP at department (EF)
  • Responds to other departements when Medicare claim processing info 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 customer care call center, client correspondence, or client demands stemming from other healthcare facility departments or management. (EF)

GROWTH/INNOVATION 25% Independently makes use of offered 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 academic tools to remain existing with the Medicare Program. This consists of participating in 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 company responsibilities as designated by the instant manager and other management as needed. The Houston Methodist Hospital schedules the right to modify or alter task tasks and obligations as the requirement occurs.

EDUCATION REQUIREMENTS

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