QUALIFICATIONS
Minimum Requirements
Established experience (more than one year) of cmael dcoi llections, accounts receivable, or third
party payors in some combination of the followinrge aas: Medicare, Medicaid, and private payers
(including manual and computerized physician bgil)li.n Experience preferred in tertiary care, State
of Texas Workman's Compensation and Departmenat boof rL regulation and procedure.
Required Knowledge, Skills, and Abilities:
Comprehensive, working knowledge of billing proceess asnd medical codes;
Excellent PC skills with working knowledge and erxiepnece with computerized billing systems
and electronic claims submissions;
Ability to identify reimbursement issues;
Ability to troubleshoot denied claims from all ohfe t organization's payers;
Knowledge of medical terminology and medical proucreds as related to physician and clinical
support billing codes;
Experience with medical necessity criteria
Ability to conform to departmental performance sdtarnds;
Ability to self regulate work, including settingm tei lines and reminders relative to accounts;
Ability to establish and maintain effective work inreglationships with superiors, co-workers,
and subordinates, patients, and the public;
Ability to communicate well in both oral and wrintt eform;
Ability to maintain confidential information;
Basic knowledge of clinical m– edical documentation requirements
Ability to communicate effectively with a varietyf iondividuals, including peers, managers,
patients, and the public;
Ability to work as a team player.
DUTIES AND RESPONSIBILITIES
General Statement
Under the direction of the Collections Supervispoerr,f orms professional tasks relative to rebilling,
account resolution, and denials management. Resisbpiloitnies include charge entry, account
management and insurance appeals. Assists withr ortghaenizational staff to collect all available
reimbursement for services performed. Performste rde lwa ork as required.
Statement of Duties:
Reviews encounter forms;
Analyzes account detail (charges, payments, anuds tamdej nts) and answers detailed questions
from third parties regarding claims or accountu sst,a at s directed;
Assists the Collections Supervisor to identify apnrodv ide solutions for denials to obtain proper
reimbursement osf ervices;
Collaborates with employees across the organiz awtiothn assistance or education regarding
medical necessity, authorization, or documentarteioqnu irements;
Prepares letters of rebuttal or clarification ofd miceal necessity;
Works collaboratively with billing staff to troubslehoot denials;
