Job Information
Houston Methodist Insurance Biller - (Museum District) in Houston, Texas
At Houston Methodist, the Insurance Biller position is responsible for processing all billing related functions within the Centralized Business Office (CBO). This includes, but is not limited to, resolution of charge review (where applicable) and claim edits, payor rejections, unresolved or no response insurance claims and processing of financial correspondence. The Insurance Biller demonstrates general knowledge of billing practices and maintains departmental standards relating to insurance claims processing, charge entry and billing functions. This role is also responsible for providing support to other departments within the CBO related to billing functions, including communicating claim issues to departmental management for further discussion with payor representatives and other key stakeholders as needed and as applicable.
PEOPLE ESSENTIAL FUNCTIONS
Provides support for the revenue cycle departments (as applicable: payment posting, coding and accounts receivable (AR) follow up) related to administrative duties as needed. Collaborates with the revenue cycle teams to follow up on missing data that may delay claims submission and payment. Collaborates with internal CBO department and Account Managers to identify and prevent claims processing errors.
Assists with knowledge sharing, payor and department training, and provides support to other team members as advised by the manager and/or supervisor. Resolves routine insurance billing inquiries and problems within departmental standards.
SERVICE ESSENTIAL FUNCTIONS
Follows established departmental workflows within the electronic health record system appropriate work queues in response to correspondence/reports/data/requests received.
Processes financial/insurance correspondence received associated to billing functions.
Pulls explanation of benefits when requested or as needed to file secondary claims.
QUALITY/SAFETY ESSENTIAL FUNCTIONS
Meets departmental productivity and quality standards. Completes claim edits timely, compliantly, and without errors. Documents clear, concise and complete notes in system for each account worked.
Identifies claim processing issues and general billing trends. Notifies supervisor and/or manager regarding trends to avoid further delay in claims processing.
Demonstrates understanding of fundamentals of all payors, including Medicare, Medicaid and commercial payors, and applicable revenue cycle operations.
Maintains strict confidentiality of patients, employees and hospital information at all times. Ensures protection of private health and personal information. Adheres to all Health Insurance Portability and Accountability Act (HIPAA) and Payment Card Industry (PCI) compliance regulations.
FINANCE ESSENTIAL FUNCTIONS
Ensures claims are submitted within payor deadlines and reports barriers to claim submission to management.
Completes billing functions within established departmental standards including billing related work queues and workflows to ensure claims are billed accurately, compliantly, and timely. Resolves basic edits, rejections, and unresolved/no response insurance claims. Processes actions to resolve clearinghouse billing, rejections, and eligibility related errors to ensure timeliness of charge/claim submission.
Monitors and processes all `no response' claims for timely resolution of services within established work queues.
Where applicable, submits accurate adjustments based on billing guidelines and departmental policies, contract requirements, or levels of authority.
GROWTH/INNOVATION ESSENTIAL FUNCTIONS
- Remains current on billing guidelines and regulations of various payors and/or specialty practices as directed by the supervisor and/or manager. Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development.
This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
EDUCATION
- High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
WORK EXPERIENCE
- Two years of professional or hospital billing experience, as applicable to the department
LICENSES AND CERTIFICATIONS - REQUIRED
- N/A
KNOWLEDGE, SKILLS, AND ABILITIES
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
Working knowledge of professional fee insurance requirements
Familiarity with general International Classification of Disease (ICD) and Current Procedural Terminology (CPT) coding, payor filing deadlines, and electronic data elements required for clean claim submission
Ability to be self-motivated, detail oriented, and work independently with minimal supervision
Proficient computer skills and ability to learn and navigate multiple software programs
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
Uniform No
Scrubs No
Business professional Yes
Other (department approved) No
ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
- On Call* No
TRAVEL
Travel specifications may vary by department
May require travel within the Houston Metropolitan area No
May require travel outside Houston Metropolitan area No
Company Profile:
Houston Methodist Specialty Physician Group is an integral part of Houston Methodist’s overall strategy to become one of the nation’s leading academic medical centers. Established as a nonprofit corporation certified by the Texas State Board of Medical Examiners, the Specialty Physician Group enables physicians to maintain autonomy with respect to clinical practice while growing their practice within an academic environment.
Houston Methodist is an equal opportunity employer inclusive of women, minorities, disabled persons and veterans.
Equal Employment Opportunity
Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.
Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.
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