Reimbursement Officer (325)

HELEN FARABEE CENTER•Wichita Falls, TX

7d•Onsite

About The Position

This position is responsible for processing and posting all incoming payments from clients, Medicare, Medicaid, and insurance plans. Responsibilities include, but are not limited to: Position will maintain payment spreadsheet and forward Early Childhood Intervention (ECI) payments to appropriate staff. Will complete payment/denial entry into the SmartCare data system in a timely and accurate manner ensuring all payments are posted by month end. Ensures payments are being paid at the allowed/contract amounts and communicates any issues to the Reimbursement Coordinator. Research all denied claims and appeals or resubmits as required within specified time frames. Completes general ledger spreadsheets via Excel and/or using data system reports ensuring data is accurate and all payments are documented. This position is also responsible for processing the Substance Abuse Program billing for all Department of State Health Services (DSHS) funded services through the Clinical Management for Behavioral Health Services (CMBHS) computer system. Will maintain the Substance Abuse program payments spreadsheet and distribute to required staff each month. Will process/fax Service Request Forms (SRF) daily to request authorization for services to ensure proper payment. Position will verify client Medicaid eligibility using the Texas Medicaid Healthcare Partnership (TMHP). Position will verify insurance using the Availity application. Position serves as backup to the Medicaid Administrative Claiming (MAC) Coordinator and will attend all required trainings. As directed by MAC Coordinator, position will submit participant lists, remind, and assist staff with Random Moment Time Study (RMTS) completion, and assist with completion of quarterly Medicaid percentage. Position also serves as backup for Fax Intake when directed by Reimbursement Coordinator. Will also serve as backup trainer for financial training to new staff. Position requires ability to perform complex data entry and ability to run reports from various computer systems. Position requires initiative, excellent communication, and organizational skills with the ability to interact in a professional manner with a variety of staff, consumers and other community and State agencies. Work is performed with minimal supervision within established guidelines, policies, and procedures. Must attend all assigned meetings. HFC incorporates principles of trauma-informed care throughout the agency, emphasizing cultural sensitivity and a safe and respectful environment for all individuals served and staff. All job descriptions include the responsibility to learn about and implement trauma-informed practices within the scope of work for the position. Reassignment is a condition of employment that may occur at the employer’s discretion. Your work location and hours could change based on program needs.

Requirements

Graduation from standard high school or equivalent.
Must be able to effectively use a computer and have a working knowledge in creating simple spreadsheets.
Must have valid driver’s license and be insurable to drive Center vehicles.
Must pass and maintain all Center mandate trainings and all trainings required for certification.
Ability to read and proof correspondence, reports, computer printouts, etc.
Excellent spelling and grammar.
Ability to write memos, letters, various complex reports, miscellaneous documents.
Ability to perform simple to moderate math.
Ability to relate to verbal instructions and communicate in a courteous and effective fashion.
Skilled in the use of personal and network computers, spreadsheet, and office management software (Microsoft Office).
Ability to use copy machine, fax machine, computer, telephone, and printer.
Initiative, excellent communication, and organizational skills with the ability to interact in a professional manner with a variety of staff, consumers and other community and State agencies.
Ability to perform complex data entry and ability to run reports from various computer systems.

Nice To Haves

Training in the field of medical billing is a plus.

Responsibilities

Processing and posting all incoming payments from clients, Medicare, Medicaid, and insurance plans.
Maintaining payment spreadsheet and forwarding Early Childhood Intervention (ECI) payments to appropriate staff.
Completing payment/denial entry into the SmartCare data system in a timely and accurate manner, ensuring all payments are posted by month end.
Ensuring payments are being paid at the allowed/contract amounts and communicating any issues to the Reimbursement Coordinator.
Researching all denied claims and appealing or resubmitting as required within specified time frames.
Completing general ledger spreadsheets via Excel and/or using data system reports, ensuring data is accurate and all payments are documented.
Processing the Substance Abuse Program billing for all Department of State Health Services (DSHS) funded services through the Clinical Management for Behavioral Health Services (CMBHS) computer system.
Maintaining the Substance Abuse program payments spreadsheet and distributing to required staff each month.
Processing/faxing Service Request Forms (SRF) daily to request authorization for services to ensure proper payment.
Verifying client Medicaid eligibility using the Texas Medicaid Healthcare Partnership (TMHP).
Verifying insurance using the Availity application.
Serving as backup to the Medicaid Administrative Claiming (MAC) Coordinator and attending all required trainings.
As directed by MAC Coordinator, submitting participant lists, reminding, and assisting staff with Random Moment Time Study (RMTS) completion, and assisting with completion of quarterly Medicaid percentage.
Serving as backup for Fax Intake when directed by Reimbursement Coordinator.
Serving as backup trainer for financial training to new staff.
Performing complex data entry and running reports from various computer systems.
Attending all assigned meetings.