WORKSITE LOCATION: Gulf Bend Regional Plaza, 6502 Nursery Drive, Suite 100, Victoria TX 77904
PAY GRADE:9 EEOC CODE: Adm Support Workers FLSA STATUS: Non-Exempt
SHIFT: Fulltime; Monday thru Friday, 8:00am - 5:00pm
JOB PURPOSE: Responsible for insurance SB58 authorizations, maintenance of Payor Plans in the EHR System, generate monthly statements and review for accuracy, assist with customer questions related to their insurance or monthly ability to pay (MAP) share, eligibility of verification of the 270/271 files, assist with daily provider schedules, assist with posting insurance and customer share payments in the EHR System, collections of outstanding accounts receivable balances and appeal denied claims. Work outstanding AR balances with insurance follow up and appealing denied claims. Perform all other job duties as assigned.
ESSENTIAL FUNCTIONS and DUTIES:
1. Fax the SRF authorization for SB58 to insurance Payors and update HER system, print and review all customer statements prior to mailing, request the 270/271 Medicaid eligibility and make the necessary changes in the HER System.
2. Call Payors or work in the portal to determine the status of claims; must maintain a log of the progress for outstanding accounts.
3. Appeal denied claims and keep a log of the progress until the services are paid.
4. Assist with applying insurance payments when needed.
5. Understand trauma informed services.
REPORTS TO: Revenue Manager
LEVEL OF SUPERVISION REQUIRED: General
KNOWLEDGE, SKILLS, ABILITIES, and COMPETENCY:
Trauma-informed: A trauma-informed approach to care "realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved in the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization." The six key principles of a trauma-informed approach include: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and cultural, historical and gender issues.
ESSENTIAL FUNCTIONS AND DUTIES:
1. Understands trauma-informed services.
2. Understands the Three E's of trauma-informed care.
3. Understands the Four R's of trauma-informed care.
4. Understands the six key principles of trauma-informed care.
1. Strong written and verbal communication skills to communicate clearly through email and telephone with strong interpersonal skills.
2. Ability to solve problems and resolve issues.
3. Detail oriented.
4. Cross-training with department functions.
5. Must be a team player.
6. Ability to deal with difficult situations.
7. Ability to operate a computer, office equipment and office software such as Excel, Word, and Adobe.
8. Organization skills for multitasking.
9. Ability to meet deadlines and coordinate with external agencies for data consistency and integrity.
EQUIPMENT, TOOLS AND MATERIALS
1. Computer, telephone, VCR, projectors, calculator, computer, fax machine, and copy machine are used in performance of essential job duties.
2. Various forms of paperwork are handled in performance of essential job duties.
EDUCATION AND EXPERIENCE REQUIRED: High School Diploma or GED equivalent with two years' work experience in accounts receivable and Payor appeals.
Preferred: Data processing including experience with personal computers, spreadsheets (formatting, calculations, reporting), data-base and reporting, correspondence, word processing.
DEGREE AND/OR CERTIFICATION REQUIRED: n/a
PHYSICAL REQUIREMENTS and ENVIRONMENTAL CHECKLIST: 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, ability to tell time.
Work site and environmental conditions that apply to this job: Inside, working closely with others, working alone.
CRED/PRIV REQUIRED? No DRIVING REQUIRED: No
OTHER REQUIREMENTS OR CONDITIONS:
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.