Senior Reimbursement Specialist - Revenue Integrity - Business Services Group

 
Position: Senior Reimbursement Specialist - Revenue Integrity - Business Services Group

Job ID: 164805

Location: US-TX-Houston

Department: REVENUE INTEGRITY

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.   Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.   To join our community of 14,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.  At Texas Children’s Hospital, diversity, equity, and inclusion are at the core of our values and mission for the patients and their families that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for a Sr. Reimbursement Specialist – someone who works well in a fast-paced managed care setting. In this position, you will design, develop, and manage the denial and underpayment databases for Patient Accounting. This role will primarily be responsible for monitoring and tracking managed care reimbursement and denials to provide weekly, monthly, and yearly reports to management of trends.

 

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Responsibilities :

Job Duties & Responsibilities 

  • Creates and maintains denial and underpayment databases to ensure that all denied and underpaid accounts are identified and trended to improve collections and reduce denials
  • Assists Patient Account Managers with training in resolving reimbursement issues related to managed care and other discounted accounts
  • Meets with payers to maintain productive relationships with the insurance companies, managed care organizations, and government agencies to resolve reimbursement and slow payment problems
  • Provides weekly, monthly, and annual reports for Business Service Leadership and VP of Finance to manage and monitor Accounts Receivable and Revenue Cycle
  • Provides period audits on accounts by payer to ensure that accounts are reimbursed appropriately, and contractual discounts are recorded accurately
  • Develops reimbursement reports for the Health Centers and Learning Support centers
  • Works closely with Decision Support team to ensure that reimbursement and collections data is accurate
  • Develops and maintains positive relationships with physicians, providers, and practice managers throughout the delivery system
  • Actively participates in the development and implementation of the action plans for the department in response to Business Services adoption of Continuous Quality Improvement


Qualifications:

Skills & Requirements 

  • High School Diploma or GED
  • 7 years of experience in accounting, contracting, collections, provider relations, or patient access area
  • A Bachelor’s degree may substitute for 4 years of the required experience
  • Knowledge of State, Federal, and third-party claims processing and the laws of the State Insurance Board and Fair Collection Act
  • Understand all types of managed care payment plans such as HMO’s, PPO’s, POS, and EPO plans
  • Proficient with computer skills such as word processing, spreadsheets, and database software
  • Basic understanding of mainframe systems, utilizing basic office equipment, and ability to provide customer service
  • Good written and verbal communication skills, strong analytical skills, and the ability to multi-task
  • Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s, unless approved for a medical or religious exemption


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