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PBS Specialist- Hospital Billing/Collections
Key Functions
1. Responsible for managing payment variance claim work queues for follow-up of underpayments by engaging payor websites and initiating calls in order to ensure prompt correct payment.
2. Initiate appeals processes for underpaid claims, including gathering supporting documentation to assist in appeal review process.
3. Identifies underpayment trends and determines root causes for discrepancies and provide feedback to management.
4. Collaborate with Managed Care as needed in review of contract build when issues are identified to verify build is accurate.
5. Responds to requests made by third party payers and in a timely manner.
6. Consistently reviews processes and recommends any areas of opportunities with assigned payors or with patient accounting system.
7. Assists with training other team members.
8. Written communication demonstrates clear action taken on each account as well as what further action is needed to capture underpayment. Work output is documented clearly, so that various departments involved in resolution can review the account.
9. Ability to meet departmental standard for quality and productivity.
10. Other duties as assigned.
EDUCATION
Required : Associate's Degree Business Administration or related field.
Preferred: Bachelor's Degree Business Administration or related field.
WORK EXPERIENCE
Required: Four years In healthcare to include two years experience in billing, governmental regulations and/or claims adjustment. Required May substitute required education degree with additional years of equivalent experience on a one to one basis.
Preferred: Hospital billing and collections experience, experience reviewing payor contracts, identify variances in payments, strong analytical skills.
OTHER REQUIREMENTS
Must pass pre-employment skills test as required and administered by Human Resources.
It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html
