-
Insuring Resolution Specialist
2 weeks ago
D.R. Horton Austin, United States*D.R. Horton, Inc., the largest homebuilder in the U.S.,*was founded in 1978 and is a publicly traded company on the New York Stock Exchange. It is engaged in the construction and sale of high quality homes designed principally for the entry-level and first time move-up markets. ...
-
Compliance and Customer Resolution Specialist
2 weeks ago
Hippo Insurance Austin, United StatesRole: Compliance and Customer Resolution Specialist · Location: Austin, TX / Dallas, TX / Bedminster, NJ (Hybrid) · Reports to: Director, Insurance Operations · About Hippo: · Our mission is to deliver intuitive and proactive protection for homeowners, combining the power of tech ...
-
Compliance and Customer Resolution Specialist
2 weeks ago
Hippo Insurance Austin, United StatesRole: Compliance and Customer Resolution Specialist · Location: Austin, TX / Dallas, TX / Bedminster, NJ (Hybrid) · Reports to: Director, Insurance Operations · About Hippo: · Our mission is to deliver intuitive and proactive protection for homeowners, combining the power of ...
-
Insuring Resolution Specialist
1 week ago
D.R. Horton Austin, United States*D.R. Horton, Inc., the largest homebuilder in the U.S.,*was founded in 1978 and is a publicly traded company on the New York Stock Exchange. It is engaged in the construction and sale of high quality homes designed principally for the entry-level and first time move-up markets. ...
-
Insuring Resolution Specialist
3 weeks ago
D.R. Horton Austin, United StatesD.R. Horton, Inc., the largest homebuilder in the U.S., · was founded in 1978 and is a publicly traded company on the New York Stock Exchange. It is engaged in the construction and sale of high quality homes designed principally for the entry-level and first time move-up markets ...
-
Texas Department of Aging & Disability Services Austin, United StatesJob Description: · Performs complex (journey-level) computer systems analysis work as part of the Electronic Benefits Transfer (EBT) Operations Branch in the Vendor Management and Operations Unit within the Special Supplemental Nutrition Program for Women, Infants, and Children ( ...
-
Patient Account Resolution Specialist
3 weeks ago
Apria Healthcare LLC Austin, United StatesAt Owens & Minor, we are a critical part of the healthcare process. As a Fortune 500 company with 50+ facilities across the US and 18,000 teammates in over 90 countries, we provide integrated technologies, products and services across the full continuum of care. Customers—and the ...
-
Health & Human Services Comm Austin, United StatesPerforms complex (journey-level) computer systems analysis work as part of the Electronic Benefits Transfer (EBT) Operations Branch in the Vendor Management and Operations Unit within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Responsible f ...
-
Quality Assurance Spec III
2 weeks ago
Texas Department of Aging & Disability Services Austin, United StatesJob Description: · Quality Assurance Spec III · This position schedule is Saturday-Wednesday 8 AM-5 PM. · Serves as a Quality Assurance Monitoring Specialist with the Quality Assurance Unit. Quality Reviews include Long Term Care, Home and Community Support Services Agency (HCSSA ...
-
Medical Laboratory Scientist 2
1 week ago
Baylor Scott & White Health Austin, United States Full timeJOB SUMMARY · Schedule: Night Shift-Variable hours · The Med Lab Scientist 2 performs and monitors a full range of laboratory testing and research. Assumes responsibility for problem resolution, quality control, and required equipment maintenance with minimal supervision. · ESSEN ...
-
Contract Specialist III
3 weeks ago
Texas Department of Aging & Disability Services Austin, United StatesJob Description: · Contract Specialist III · The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Contract Specialist III. MCS is driven by its mission to deliver quality, cost-eff ...
-
Program Specialist VI
1 week ago
Texas Department of Aging & Disability Services Austin, United StatesJob Description: · Program Specialist VI · Under the direction of the OCBCT Director this position is responsible for directing Community-Based Care (CBC) implementation and operations activities. This position interacts often with DFPS staff, the SSCC, other agencies in the comm ...
-
Authorization & Referral Coordinator II
1 week ago
Austin Regional Clinic Austin, United States Full timeABOUT AUSTIN REGIONAL CLINIC: · Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 10 years We are one of central Texas' largest professional medical groups with 25+ locations and we are continuing to grow. We offer the following benefit ...
-
Community Engagement Coordinator
4 weeks ago
PriceSenz Austin, United StatesJob Summary: · The Community Engagement Support Specialist, reporting to the Community Engagement Coordinator, plays a vital role in fostering community relationships. This position involves assisting with programs aimed at developing understanding and obtaining informed consent ...
-
Cloud System Admin
2 weeks ago
Luna Data Solutions Austin, United StatesWe are currently looking for an IT Procurement Specialist for a long-term opportunity in Austin, TX. This is a HYBRID role. Local candidates only. · **** MUST have an active Certified Contract Texas Developer (CTCD)certification. **** · This specialist will be part of the Con ...
-
Python Developer
1 week ago
TALENT Software Services Austin, United StatesAre you an experienced Python Developer with a desire to excel? If so, then Talent Software Services may have the job for you Our client is seeking an experienced Python Developer to work at their company 100% remotely. · Primary Responsibilities/Accountabilities: · Designs, code ...
-
Contract Specialist V
1 week ago
Texas Department of Aging & Disability Services Austin, United StatesJob Description: · Contract Specialist V · Under the supervision of the Financial Branch Manager, provides team leadership and support in contract management with minimal supervision and with extensive latitude for the use of initiative and independent judgment. Performs highly a ...
-
Billing Specialist
4 days ago
DentalMonitoring Austin, United States Permanent Full timeRole and Responsibilities · Manage monthly billing process (customer payment allocation, discount, refund, orders application in DM systems and tools) for North America · Responsible for invoicing (creation of invoices in the system, monitoring of contractual clauses and payments ...
-
Quality Assurance Spec III
3 weeks ago
Texas Department of Aging & Disability Services Austin, United StatesJob Description: · Quality Assurance Spec III- Serves as a Quality Assurance Monitoring Specialist with the Quality Assurance Unit. Quality Reviews include Long Term Care, Home and Community Support Services Agency (HCSSA), Health Care Quality/Acute Care (HCQ), and Substance Abus ...
-
Contract Specialist IV
2 weeks ago
Texas Department of Aging & Disability Services Austin, United StatesJob Description: · Contract Specialist IV The HHSC Medicaid CHIP Services (MCS) division seeks a highly qualified candidate to fill the position of Contract Specialist IV. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a si ...
Claims Resolution Specialist - Austin, United States - Austin Regional Clinic
Description
Administration6210 US-290 E
Austin, TX 78723, USA
Description
ABOUT AUSTIN REGIONAL CLINIC:
Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 10 years We are one of central Texas' largest professional medical groups with 25+ locations and we are continuing to grow.
Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more.
For additional information visitPURPOSE
Responsible for processing follow up actions on claims denied for eligibility-related reasons and responding to health plan correspondence. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.
ESSENTIAL FUNCTIONS
Takes appropriate follow up action on denied claims based on the ANSI Reason Code , payer policy, eligibility and so forth.
Either prepares appeals, performs write off actions or assigns financial responsibility to next party in accordance with company policy.Uses Epic In-Basket messages to communicate with appropriate staff to obtain authorization to edit claim data and other assistance with follow up and/or appeal actions.
Reviews procedure and diagnosis codes to make sure they conform to third party rules and ensure appropriate reimbursement.Researches insurance payments and ANSI reason code denials to determine correct posting information.
Edits claims through Correct/Report actions to reflect complete, accurate & updated information.
Processes and submits appeals in accordance with payer policy.
Maintains and follows up on accounts appropriately and clearly and accurately documents issues, sources and actions taken to describe activities and results in Account Contact.
Reviews accounts for credits and requests refunds to insurance companies or patients as necessary.Submits EOB to the Supervisor and Team lead for approval to adjust adjust any charges that over $250.00.
Informs and works with management team when all usual attempts to collect from third parties and/or customers have failed to result in adequate reimbursement.
Follows up with insurance carriers on problematic coverage issues.Follows up with insurance carriers on problem payments and adjustments.
Utilizes payer and clearinghouse web-sites for claims status or eligibility.
Completes assigned department problem tickets
Opens a weekly system batch to store correspondence & other documents; references batch number in account notes to cross reference document location.
Opens, closes, and process batches according to departmental guidelines.Generates any adjustments necessary to complete posting of payments.
Uses appropriate Epic Functions, write off codes and ANSI Remark codes when performing actions through Account Maintenance
Adds a termination date to patient coverage when claim is denied "coverage termed."
Reviews and follows up on Patient Account Teams' inquiries according to established policy.
Documents daily performance on weekly productivity log.
Identifies and documents new payer denial trends, and notifies supervisor for escalated follow up.
Escalates unresolved claim denials to supervisor for follow up with health plan provider representatives.
Performs all duties within established departmental time frames.
Regular and dependable attendance.
Attends required in-service / training sessions. Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
Follows the core competencies set forth by the Company, which are available for review on CMSweb.
Thoroughly researches reasons for denied claims in assigned work queues to resolve outstanding balances.
Acts upon payer correspondence in a timely manner and uses Eligibility Follow Up Work Queue to process response as appropriate.
Utilizes the work queue Assistant to track follow up activities.Manages accounts assigned to the work queues using work queue ticklers.
Places account notes in Account Contact to document all activities and results.
Reviews work queue summary for each correspondence account and completes from work queues as appropriate.
Respond to Patient/Customer to confirm receipt of / or provide resolution to written correspondence.
Forwards requests for Registration verification and updates to the Registration Team.
OTHER DUTIES AND RESPONSIBILITIES
Provides back up to Customer Service and assistance to the Central Registration call center.
Meets job standards for Patient Registration and Posting positions.
Keeps complete, accessible and dated files.
Verifies insurance eligibility and sets up accounts by account type classifications.
Provides workload statistic reports to management team.
Assists in training other staff members.
Provides assistance to coworkers as requested and/or necessary.
Performs other duties as assigned.
QUALIFICATIONS
Education and Experience
Required:
High school diploma or GED. Experience using computer data processing systems. Two (2) or more years of experience working in a medical office setting.
Knowledge, Skills and Abilities
Knowledge of and/or experience with Medicare, Medicaid and commercial insurance plan. registration, and eligibility verification.
Knowledge of and/or experience with procedural and diagnostic coding.
Knowledge of patient copay vs. cost share responsibility.
Ability to engage others, listen and adapt response to meet others' needs.
Ability to align own actions with those of other team members committed to common goals.
Excellent computer and keyboarding skills, including familiarity with Windows.
Excellent verbal and written communication skills.
Ability to manage competing priorities.
Ability to perform job duties in a professional manner at all times.
Ability to understand, recall, and apply oral and/or written instructions or other information.
Ability to organize thoughts and ideas into understandable terminology.
Ability to apply common sense in performing job.
Work Schedule:
Monday through Friday 8am-5pm
#J-18808-Ljbffr
