Reimbursement Officer I
About The Position
Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage. Would you thrive in an environment where you learn and grow personally and professionally all while helping make a positive impact on people’s lives? Do you appreciate being around others like yourself who are dependable, trustworthy, hard workers who believe in the value of teamwork? HSCS is dedicated to building an atmosphere where employees feel valued and supported while providing specialized care for Texans in need. HSCS is comprised of nine psychiatric hospitals, one youth residential treatment facility, and thirteen state supported living centers. The psychiatric hospitals are a hub of excellence for forensic mental health and complex psychiatric care, with all facilities accredited by The Joint Commission. They provide state-of-the-art treatment that is recovery-oriented and science-based. If providing hope and healing through compassionate, innovative, and individualized care interests you, we welcome your application for the position below. Performs routine reimbursement or claims processing work. Maintains files on each covered individual, gathers all rendered reimbursable services from the individual’s charts for purpose of billing. Maintains a working master list containing Medicare or other third-party payor information on each individual covered. Participates in reimbursement audits. Works under moderate supervision, with limited latitude for the use of initiative and independent judgment. Performs other duties as assigned. Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location. This position may be eligible to earn additional pay for work performed on evenings, nights and/or weekends.
Requirements
- Knowledge of the principles of collection and accounting.
- Knowledge of the rules and regulations governing reimbursement for agency services.
- Knowledge of the workings of Medicare Part A, Part B and Part D, as well as ICD-10-CM, CPT and HCPCS codes used when gathering monthly billing information.
- Skills in use of Electronic Health Records.
- Skills in the use of general office equipment.
- Skills in the operation of computers and applicable computer software.
- Ability to communicate effectively.
- Two years’ experience in claims processing and health-related account and collection work.
Responsibilities
- Attends work on a regular basis and may be asked to work a specific shift schedule or, at times, even a rotating schedule, extended shift and/or overtime in accordance with agency leave policy and performs other duties as assigned.
- Gathers all rendered, reimbursable services for individuals with Medicare or other third-party payor on a monthly basis. Meets with hospital physicians to ensure the codes used are the most accurate for rendered services.
- Prepares a Monthly Charge Report for individuals with Medicare or other third-party payors, using information pulled from AVATAR and individuals' medical records. Reviews the information for accuracy and makes corrections as necessary using a current Fee Schedule.
- Enrolls eligible individuals into a Medicare Part D Drug Program that best fits the patient’s needs and enters the information in the online CARE System.
- Establishes and maintains records on a daily basis, including documents, correspondence, forms, and lists for each patient with Medicare or other third-party payor on campus, as well as maintains an Excel list with information updates as necessary.
- Prepares Medicare enrollment or revalidation forms for physicians who are employed or contracted by the hospital.
- Assists in Medicare or other third-party payor audits, and other related work, as required.
- Performs other duties as assigned. Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location.
Benefits
- comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees
- defined benefit pension plan
- generous time off benefits
- numerous opportunities for career advancement
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
