Reimbursement Officer

TX-HHSC-DSHS-DFPS

10d • Onsite

About The Position

Come work in an environment where we truly value and respect those we serve and believe in the mission that all people can achieve a higher level of wellness and independence.

The state supported living centers serve people with intellectual and developmental disabilities who are medically fragile or who have behavioral problems. The centers provide campus-based direct services and supports at 13 centers located throughout the state. Learn About Our State Supported Living Centers

If you are looking for a place to work where you can establish a career that is filled with purpose, this is the job for you!

Reimbursement Officer IV plans, directs, and monitors the activities of the State Supported Living Center’s Reimbursement office for services furnished by ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disabilities) facilities. Performs advanced (senior-level) reimbursement claims processing work. Performs professional, technical, and administrative duties managing the reimbursement office in a State Supported Living Center (ICF/IID) facility. Supervises the determination and assessment of proper reimbursement rates, maintenance of accounts receivable, and collection of charges for services provided by the facility specifically with Medicare, Medicaid, & Hospice billing. Works directly with State Office Revenue Management staff, exercising a significant degree of initiative and independent judgement in the performance of duties, supervising one or more subordinates in their performance of reimbursement tasks. Manages the work of other Reimbursement Office staff and may assign duties as warranted to ensure proper completion and response of reimbursement tasks. Reports to facility Assistant Director of Administration.

Requirements

• Knowledge of billing, collecting, and account maintenance procedures in an institutional setting.
• Knowledge of HHSC rules and procedures related to records, account reconciliations, and confidentiality (HIPPA).
• Knowledge of HHSC mainframe computer applications, EHR (electronic health record), electronic billing, and personal computer applications related to reimbursement.
• Knowledge of various federal and state laws, regulations, and programs (Medicaid, Medicare, Social Security, Veterans Administration., Railroad Retirement, CHAMPUS) related to reimbursement for services performed at the facility.
• Familiarity with facility trust fund rules and procedures related to collection of reimbursement for services.
• Knowledge of Microsoft programs including Outlook, Word, Excel, Access, and any other applicable computer skills.
• Ability to perform mathematical computations, and to understand and perform complex technical procedures.
• Considerable knowledge of health-related accounting and collection procedures, and use of automated data processing in such procedures; of personnel management and office practices; and of federal and state laws, government regulations and agency rules governing reimbursement for agency services.
• Ability to select, train, and supervise qualified personnel in the technical and administrative duties of Reimbursement Office operations.
• Experience in claims processing and health-related account and collection work.
• Bachelor’s degree from an accredited college or university with major course of study in business administration or related field, and two (2) years responsible progressive experience in health-related account and collection procedures with supervisory experience; or high school graduation or equivalent and three (3) years’ work experience in a related field involving administrative and technical responsibilities.

Responsibilities

• Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
• Performs various activities necessary to collect Medicaid under the ICF/ID program: completes and submits applications and Forms 90-I; calculates billing rates; maintains accounts in automated mainframe data system; monitors and reports changes in individuals' income, resources, and level of care to Texas Health and Human Services and Social Security; and calculates monthly work earning budgets. All activities conform to established procedures as stated in the ID Reimbursement Policy and Procedure Manual.
• Performs various activities necessary to enter non-third-party financial transactions into the automated data system. All activities conform to established procedures as stated in the ID Reimbursement Policy and Procedure Manual.
• Completes application process for benefits from Social Security, Supplemental Security Income, VA, Civil Service and Railroad programs on behalf of individuals with potential eligibility. All activities conform to established procedures as stated in the ID Reimbursement Policy and Procedure Manual.
• Performs various activities necessary to maintain Medicaid eligibility; completes all required Medicaid eligibility forms; Form 1200-PFS, PFS-2, SSA-454, and SSA-455. All activities conform to established procedures as stated in the ID Reimbursement Policy and Procedure Manual.
• Performs office functions, including maintenance of files, distribution of daily mail, answering telephone, greeting visitors, work processing and photocopying documents. All activities conform to established procedures as stated in the ID Reimbursement Policy and Procedure Manual.
• Reviews of VPS system reports and takes necessary action. All activities conform to established procedures as stated in the ID Reimbursement Policy and Procedure Manual.
• Monitors various activities necessary to collect Medicare Part B reimbursement for physicians' services including consultation and surgery and ancillary services including lab, radiology, EEG, EKG, vaccines, injections, and venipunctures. All activities conform to established procedures as stated in the ID Reimbursement Policy and Procedure Manual.
• Performs and/or oversees staff engaged in financial interviewing, financial investigations, asset research, and fee determinations.
• Performs related work as assigned.
• Assesses training needs based on observations and monitoring of reimbursement programs.
• Interprets, establishes, and implements policies and procedures.
• Resolves billing problems and financial determinations
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees