Senior Reimbursement Specialist

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.

Think you’ve got what it takes?

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

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
 

About Texas Children’s

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 Tower 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; Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston; and Texas Children’s Hospital North Austin, the new state-of-the-art facility providing world-class pediatric and maternal care to Austin and Central Texas families. We have also created Texas Children’s Health Plan, the nation’s first HMO focused on children; Texas Children’s Pediatrics, the largest pediatric primary care network in the country; Texas Children’s Urgent Care clinics that specialize in after-hours care tailored specifically for children; and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation. 

 To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

 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.