The Harris Center for Mental Health and IDD is hiring a Revenue Representative – Appeals and Collection. The Revenue Appeals and Collection Representative reviews, disputes, and resolves denied healthcare claims from commercial and government insurance payers to maximize reimbursement and meet collection targets. This role supports reimbursement maximization through proactive insurance collections and denial processing to ensure timely payment.
Key responsibilities include analyzing denial details, researching payer policies, preparing and submitting appeals, following up on payer correspondence, and clearly documenting appeal rationale to reach final determinations in attempts to overturn denials for reimbursement. The representative monitors insurance accounts receivable, conducts follow-up with payors, and maintains accurate account documentation within billing systems.
Your role in Action
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Manages outstanding Accounts Receivable for 3rd party payer as necessary to ensure account balances are reviewed to determine collect ability.
- Analyze Explanation of Benefits (EOBs), remittance advices, claims history, medical records, and HCFA 1500 forms to determine claim accuracy and appropriate appeal strategy.
- Research payer policies, member coverage, and regulatory guidelines to support reconsiderations, disputes, and formal appeals.
- Prepare and submit timely first-level and subsequent appeals to ensure compliance with filing deadlines.
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Manage and monitor outstanding insurance accounts receivable, including follow-up with commercial and government payers to secure payment or appropriate balance adjustment.
- Conduct collection activities to resolve unpaid claims and reduce aged receivables.
- Review the status of previously appealed or pended claims to ensure resolution within established timeframes.
- Maintain accurate and detailed tracking notes in the EMR/billing systems.
- Identify denial or collection trends, recurring issues, or areas of concern and communicate findings to leadership in a timely manner.
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Collaborate with internal departments to obtain required documentation and ensure compliance with payer contracts, agency policies, and regulatory requirements.
- Maintain organized electronic copies of all appeals within designated shared folders to ensure accessibility and proper record retention.
What qualifications you will need:
Education:
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High School Diploma or General Education diploma
Experience:
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Must have one (1) year of reimbursement experience, along with working knowledge of government and commercial insurance payer guidelines and appeal process. Must be computer literate, detailed oriented and have a working knowledge of excel, ICD-10, and CPT coding.
Requires Knowledge, Skills & Abilities:
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The person must have well-developed interpersonal, organizational and problem-solving skills and be a team player with a desire to provide a high level of customer service; possess strong verbal and written communication skills and interact effectively at all levels within the organization.
About us:
The Harris Center is the state-designated Local Mental Health Authority and Local Intellectual and Developmental Disability (IDD) Authority serving Harris County, Texas. As the largest behavioral and developmental disability care center in Texas, The Harris Center provides care to over 90,000 people and has an annual budget of over $300 million.
As part of its mission to transform the lives of people with behavioral health and IDD needs in the third largest county in the United States, The Harris Center provides a full continuum of services at 80 different sites across Harris County. In addition, services are provided in more than 40 different languages as well as sign language in order to better serve what is one of the largest communities in the nation.
By utilizing the unique expertise of its more than 2,500 employees, The Harris Center is committed to meeting the behavioral health and IDD needs of Harris County residents and giving them hope to live to their fullest potential.
What else you should know:
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This posting is associated with position number 1225
What we have to offer:
The Harris Center not only offers a competitive salary but also a suite of excellent benefits designed to enrich your life both professionally and personally. Imagine a future with a robust retirement plan complemented by our generous company matching – a testament to our investment in your long-term financial well-being. Experience the unique advantage of our prior service credit, accelerating your journey towards a more substantial Paid Time Off accrual, empowering you to enjoy well-deserved breaks.
Enjoy Cell Phone Discounts, exclusive entertainment deals through Tickets at Work, and a free Headspace subscription for mental wellness. Additionally, our Employee Assistance Program supports your overall well-being.
Take advantage of significant financial relief through student loan forgiveness as a valued member of The Harris Center team. As a qualifying entity, our employees are eligible for various student loan forgiveness programs, designed to alleviate the financial burdens associated with higher education.
Contributes to suicide care and prevention by embracing our values and applying a trauma-informed approach rooted in safety, trust, choice, collaboration, and empowerment.
