IrvingRecruiter Since 2001
the smart solution for Irving jobs

PFS Associate IV - Medicare Biller

Company: CHRISTUS Health
Location: Irving
Posted on: May 28, 2019

Job Description:

Description Responsible for the duties and services that are of a support nature to the RCBS High Performance Work Teams. Ensures that all processes are performed in a timely and efficient manner. Performs assigned duties such as, cash posting, customer service, data entry and reviewing of claims for proper billing/collections. Responsible for performing billing, collections and reimbursement services of claims and duties to hospitals supported by the RCBS. In doing so, ensures that all claims billed and collected meets all government mandated procedures for Integrity and Compliance. Performs billing, collections and reimbursement services in a prompt and efficient manner. Provides thorough, courteous and professional assistance to patients, physician offices, insurance companies and other clients on an as needed basis while maintaining strictest confidence. Documents, forwards, resolves incoming mail and correspondence. Demonstrates a level of accountability to ensure data and codes are not changed on claims prior to submission if related to diagnosis, charge and/or other clinical type data that RCBS would not have knowledge of. Ensures all Compliance errors are reported to the Director and maintain records and files of documentation supporting bill changes that are directed by Director and/or Integrity Officer. Responsible to ensure successful implementation of Governmental Regulatory Billing changes, including but not limited to Medicare OPPS effective August 1, 2000. MAJOR RESPONSIBILITIES Ensures daily productivity standards are met and daily EOB'S, reports and appeal files are cleared with in 48 hours of receipt (allowing for weekends and holidays). Log IPOs as issues arise and report during shift briefing Maintains an active working knowledge of all Governmental Mandated Regulations as it pertains to claims submission. Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission. Responsible to contact Clinical departments and Medical Records in order to obtain information relevant to erred claims as possible Integrity issues. Works with Departments for proper resolution of erred claims. Maintains logs of Integrity related governmental claims and reports to Management weekly. Reviews and resolves claims that are suspended daily in electronic billing terminals in accordance with procedure. Responsible for working claims generated reports, providing proper documentation and making necessary corrections within specified times. Ensures quality standards are met and proper documentation regarding patient accounting records Reviews and resolves claims that are suspended daily in electronic billing files in accordance with procedure Ensures all correspondence, rejected claims and returned mail is worked within 48 hours of receipt (allowing for weekends and holidays). Ensures business service requests are worked and documented within 24 hours of receipt. Identifies and forwards proper account denial information to the designated departmental liaison. Dedicates efforts to ensure a proper denial resolution and timely turnaround. Monitors and communicates errors generated by other departments, communicating trends Maintains an active working knowledge of all billing and reimbursement requirements by Payer. Continuously receives updates and information regarding changes and newly revised billing and reimbursement practices and ensures compliance. Stays abreast of all government changes. Provides continuous updates and information to Business Office Management regarding ongoing errors, payer related issues, registration issues and other controllable QA related activities affecting reimbursement and payment methodology. Responsible for working all discount applicable generated reports, provide proper documentation of, make necessary corrections within two business days of receipt. Makes appropriate corrections to the hospital lost system tables to ensure system calculated contractuals are accurate. Provides ongoing regular updates and information to Managed Care analyst regarding contracted terms when discounts are calculated inappropriately. Works collaboratively with team members to assist in keeping workload evenly distributed. Ensures quality standards are met in clerical services performed in accordance with Integrity and Compliance guidelines. Review predetermined criteria to process patient and insurance refund request. Billing Review UB 04's for possible errors prior to submission to ensure accurate claims are being submitted by 3:00pm daily Submit corrected claims along with rebills to the payor daily Contacts other departments for necessary information to correctly bill claims as needed Reviews and rebills claims to the Rejection and HUB reports in SSI daily Works Meditech billers queue daily Correct claims in RTP status in either CCSM or DDE per Medicare guidelines. Initiate Medicare Redetermination, Reopening, and/or Reconsideration as needed. Ensure split bill claims are billed accurately with the proper charges on the claim. Collections Collect balances due from payors Maintain an active knowledge of all collection requirements by payors Ensures daily billing and re-bill files are cleared in accordance with documented procedures; daily EOB's, reports, correspondence, and appeal files are cleared within 48 hours of receipt Works collector queue daily Correct claims in RTP status in either CCSM or DDE per Medicare guidelines. Initiate Medicare Redetermination, Reopening, and/or Reconsideration as needed. Works correspsondence, rejected claim and return mail. Validations Ensure proper reimbursement for all services and to ensure all appeals are filed timely Review accounts and determine appropriate follow up activities utilizing Six Sigma Practices Identify under and overpayments and take appropriate actions to resolve accounts Validate commercial insurance claims to ensure the claims are paid according to the contract Direct knowledge using Meditech and CollectLogix software Monitor and communicate errors generated by other groups and evaluate for trends Requirements HS Diploma or equivalency required Post HS education preferred Must have minimum of 2 years' experience with Medicare/Medicaid insurance billing, collections, payment and reimbursement verification and/or refunds. Understanding of alternativeBusiness Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred. General hospital A/R accounts knowledge is required. College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience. Experience with the Medicare billing process -- what claims can be rebilled online vs doing a redetermination Understanding of Medicare language At least five years of experience billing, collecting and validating Medicare payment Understanding of how and when to bill Medicare as secondary Understanding of Medicare Dialysis billing How to read the information in the Common Working File -- HMO coverage, Hospice dates, COB screens etc. Hand's on experience with Medicare Remote -- DDE Understanding of and exposure to Medicare Recovery Audit Contractor Hand's on experience with working Medicare Status Locations (ex: RTP, Denied, Suspense) Experience with compiling both Redeterminations and Reopening's of Medicare claims Knowledgeable in locating and referencing CMS and/or Medicare RegulationsPandoLogic. Keywords: Medical Billing Clerk, Location: Irving, TX - 75060

Keywords: CHRISTUS Health, Irving , PFS Associate IV - Medicare Biller, Other , Irving, Texas

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


Chat Specialist
Description: Chat Specialist needs 5 - 7 years of experience in IT Chat Specialist requires: 2-4 years relevant work experience in ChatBot development
Company: Global Channel Management, Inc.
Location: Irving
Posted on: 06/18/2019

Compl Risk Mgmt Officer - RICM First Line Control Activities
Description: ul li Primary Location: United States,Texas,Irving li Education: Bachelor's Degree li Job Function: Compliance and Control li Schedule: Full-time li Shift: Day Job li Employee Status: Regular (more...)
Company: Citi
Location: Irving
Posted on: 06/18/2019

Data Protection Technical Specialist
Description: This position reports to the Data Protection Manager and will play a critical technology role during the deployment of the document classification application, known as Symantec Information Centric Tagging (more...)
Company: Digital Intelligence Systems, LLC
Location: Irving
Posted on: 06/18/2019


CDL-A Company Truck Driver
Description: New Pay Package Earn Up to 52 CPM 100 employee-owned J R Schugel gets you HOME on great OTR runs Join the carrier who promotes a family environment and a drivers-first focus 100 employee owned, J R (more...)
Company: J&R Schugel Trucking
Location: Irving
Posted on: 06/18/2019

Massage Therapist
Description: Overview:Are you ready to focus on doing what you love in a place that helps you feel and deliver your best Employer is the leader in accessible massage and skin care. As a massage therapist at our Irving, (more...)
Company: Massage Envy
Location: Irving
Posted on: 06/18/2019

Hair Stylist - Licensed - WACO, TX-170 N. New Rd., 76710
Description: Sport Clips is hiring Licensed Hairstylists, Cosmetologists and Barbers in our rapidly growing, exciting, fast-paced salons JOB DESCRIPTION Sport Clips is the nation's leading Men's and Boys' hair care (more...)
Company: Sport Clips
Location: Waco
Posted on: 06/18/2019

Hair Stylist - Licensed - IRVING, TX-7707 N MacArthur Blvd, 75063
Description: Sport Clips is hiring Licensed Hairstylists, Cosmetologists and Barbers in our rapidly growing, exciting, fast-paced salons JOB DESCRIPTION Sport Clips is the nation's leading Men's and Boys' hair care (more...)
Company: Sport Clips
Location: Irving
Posted on: 06/18/2019

Compliance Product Officer - ICRM Recovery Operations & Support
Description: ul li Primary Location: United States,Texas,Irving li Education: Bachelor's Degree li Job Function: Compliance and Control li Schedule: Full-time li Shift: Day Job li Employee Status: Regular (more...)
Company: Citi
Location: Irving
Posted on: 06/18/2019

IMPLEMENTATION COORDINATOR
Description: POSITION SUMMARY br br Leads and coordinates subject matter experts through the implementation of new and existing business opportunities. Leads and facilitates low to medium-high complexity client (more...)
Company: HealthSmart
Location: Irving
Posted on: 06/18/2019

11C Indirect Fire Infantryman
Description: As an Army National Guard Indirect Fire Infantryman, you'll be in charge of the Infantry's most powerful weapon - the mortar. As part of a mortar squad, section, or platoon, you will perform challenging (more...)
Company: Army National Guard
Location: Waco
Posted on: 06/18/2019

Log In or Create An Account

Get the latest Texas jobs by following @recnetTX on Twitter!

Irving RSS job feeds