Revenue Cycle Medical Billing Specialist

Planned Parenthood of Greater Texas • Dallas, TX

113d

About The Position

The Revenue Cycle Medical Billing Specialist is responsible for the overall account resolution of patient accounts within the revenue cycle management (RCM) process. Ensures timely billing of claims to payers and follow up of denials, appeals, recoupments and balance management. Ability to audit and provide feedback on the billing process and outcomes. Works cooperatively with other departments to ensure timely billing, reporting and patient account management. Supports the organization’s strategic plan and workplace inclusion initiatives. Abides by the organization’s mission in performing job duties. Demonstrates an understanding and commitment to PPGT’s culture of quality, safety and risk awareness.

Requirements

• High School diploma or equivalent + 2 years of relevant experience or Associate’s or Bachelor’s degree + some relevant experience.
• Relevant experience: Medical Billing, Medical Coding, Accounts Receivable experience.
• Medical Billing experience and electronic patient management (EPM) system experience preferred.
• Medical Billing and Coder Certification(s) preferred.

Responsibilities

• Reviews submission of claims by third party billing team to the clearinghouse to ensure accuracy.
• Processes reimbursements and payment adjustments with attention to detail, timeliness, and accuracy.
• Makes corrections and prepares appeals related to claim denials within the department’s established timelines.
• Monitors and reviews patient and commercial payer payment postings by the third-party revenue team.
• Prepares reports to monitor and track clean claims submissions as required.
• Maintains open, ongoing communication with other departments (i.e. Finance, Patient Access Center, Health Services), answering questions and providing guidance as necessary.
• Reviews and tracks payments and reports for unusual denial or non-payment trends and escalates these trends with supervisor.
• Monitors accounts receivable (A/R) aging claims, creates and reviews reports and researches unpaid claims for collectability - correcting and/or refiling claims as applicable.
• Assists with completion of billing audits and monthly reports to identify trends, underpayments, adjustments, refunds, and payment posting by third party billing team.
• Maintains accurate medical billing and claim records, documenting revenue from patients’ payments and insurance reimbursements.
• Assists with claim status updates, appeals, credit balance reviews, refunds and account resolution, ensuring a high level of accuracy in documentation in the organization’s electronic practice management (EPM) system.
• Assist patients as needed to resolve patient balances. Ensure patient messages and inquiries are returned within 1-2 business days.
• Tracks and trends correspondence and returned mail volume and updates patient account demographics with new address, returned mail indicator, and billing alerts as they occur.
• Reviews patient statement files submitted by third party billing team and follows up to resolve issues within the statement file process within the department’s established timelines.
• Works closely with the Clinical Applications team to ensure optimal use of the EPM system, clearinghouse and payer portals.
• Provides support to health center staff regarding daily patient account and cash balancing questions.
• Promotes and exemplifies a high performing patient access culture that embraces the organization’s workplace values of respect, caring, support, effective communication, teamwork, collaboration, accountability, and responsibility; and works with staff to create and maintain a workplace environment reflective of these values.
• Has unrestricted access to paper and electronic patient protected health information (PHI) and health records for purposes of treatment, payment, and/or healthcare operations.
• Embraces the organization’s 'In This Together' customer service standards and uses them with internal and external customers, every person, every time.

What This Job Offers

• Education Level: High school or GED