WORKSITE LOCATION: GBC Regional Plaza, 6502 Nursery Drive, Suite 100, Victoria TX 77904
PAY RANGE: $20.00 - $22.00 EEOC CODE: Admin Support FLSA STATUS: Non-ExemptSHIFT: Fulltime; Monday thru Friday, 8:00am - 5:00pm, some on-call shifts evenings or weekends
EDUCATION AND EXPERIENCE REQUIRED: A bachelor's degree from an accredited college or university with a major in business, accounting, or a related field; minimum five (5) years' experience in healthcare coding and/or billing and collection process. Experience may be substituted on a year for year basis for education.
Preferred: BBA/BS and five (5) years' experience in healthcare coding and/or billing and collection process.
ESSENTIAL FUNCTIONS and DUTIES:
1. Ensure that all items and services such as procedures, consumer visits, supplies and pharmaceuticals that are charged for through the Charge Description Master are described, coded, and priced appropriately and representation of services provided.
1. Ensure that all items and services such as procedures, consumer visits, supplies and pharmaceuticals that are charged for through the Charge Description Master are described, coded, and priced appropriately and representation of services provided.2. Coordinate directly with staff to ensure the proper codes are applied to services.
3. Research CPT Codes.
4. Attend monthly Information System and Billing Department meetings presenting new charge code descriptions and instructions for set-up.
5. Daily review and resolution of technical denials assigned to the analyst for resolution. Assist the department with the appeal process.
6. Analyze and research the underlying reason for services which are consistently denied by Payors. Communicate the findings with Supervisor.
7. Responsible for analyzing monthly authorization denials and coordinating with relevant department manager to ensure the process is maintained and oversee the denials until the claims are paid.
8. Assist department with maintaining denial log and create monthly reports to share with department manager.
9. Provide information back to the department manager for assessment prevention of future occurrence that caused the denial.
10. Evaluate Payor performance and payment trends to provide management with valuable statistics.
11. Assist the department with the processing of re-billing or rejected claims.
12. Assist the department with the monthly 'Show' report, coordinates with clinical staff for errors and omissions, and finalizes processes needed to complete the claims.
13. Set up CAQH account for new providers or link to their established one. Maintain time sensitive documents, perform attestation, and maintain files.
14. Analyze monthly reports provider credentialing report to determine the Payor progress.
15. Analyze consumer balances monthly and provide the information to the department manager.
16. Analyze unpaid Customer MAPS & coordinate quarterly meetings with appropriate staff members.
17. Assist the department with reviewing monthly customer statements.
18. Assist to team members explaining customer shares.
19. Assist as a backup to team members for provider schedules.
20. Assist with all payments, make necessary contractual adjustments and transfers customer responsibility.
21. Assist with all related payment files to include scanning and downloading the Explanation of Benefits.
22. Assist with unapplied customer payments.
23. Reviews, analysis, and research Clearinghouse transactions for rejected claims, appropriate authorizations, and uploads for all Mental Health (MH) Provider and Intellectual Developmental Disabilities (IDD) Authority Services with Texas Medicaid and all other Payers.
24. Attends monthly Information Systems (IS) Department meetings to troubleshoot identified claims billing issues.
25. Attends Managed Care organization monthly meetings with Billing Team to discuss credentialing, reimbursement, or denial issues.
26. Maintain confidentiality in compliance with federal HIPAA Regulations.
27. Ensuring compliance with applicable laws, regulations, procedures, and policies.
28. Understand trauma informed services.
PHYSICAL REQUIREMENTS and ENVIRONMENTAL CHECKLIST:
All abilities required to perform the essential and marginal tasks of this job: Walking, Operating office equipment, Standing, Light lifting, under 15 lbs., Sitting, Ability to see, Identify colors, Light carrying, under 15 lbs., Hearing (with aid), Straight pulling, Ability to write, Ability to count, Ability to read, Simple grasping, and Ability to tell time
All work site and environmental conditions that apply to this job: Travel by car 5% of time, Inside, Working closely with others, and Working alone
CRED/PRIV REQUIRED? No DRIVING REQUIRED: No
OTHER REQUIREMENTS OR CONDITIONS:
1. Current State of Texas Driver License or if you live in another state, must be currently licensed in that state. Liability insurance required.
2. Must be insurable by Center's liability carrier if employee operates a Center vehicle or drives personal car on Center business.
3. Good driving record as defined by Gulf Bend Center.
4. Must complete all CORE training requirements prior to the due date.
5. Must have computer experience to include Microsoft Word, Excel, and Outlook. Must have good organizational skills to achieve multiple deadlines. Ability to type 40 wpm.
6. Must maintain regular attendance and reliability which is critical to business operations. This is a fulltime position. Days and hours of work are Monday through Friday, 8:00am to 5:00pm or agreed upon hours 100% of the time, to ensure consistency and completeness of program's processes. Evening and weekend work may be required as job duties demand.
Gulf Bend Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identify or expression, or any other characteristic protected by federal, state, or local laws.
This policy applied to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.