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Job Summary:

Responsible for performing research and follow up activities on assigned accounts in order to obtain additional reimbursement for Praxis Healthcare Solutions, LLC. Clients.

Duties and Responsibilities (not limited to):

  • Assess accounts for balance accuracy, payer plan and financial class accuracy, billing accuracy, denials, insurance requests

  • Provide documentation appropriately and submit corrections or escalate for re- processing in a professional and timely manner

  • Resolve claim processing issues on a timely basis by reviewing claim inventories, payments and adjustments and taking appropriate actions to ensure proper discounts and allowances have been completed as well as identify applicable accounts for secondary billing and follow up

  • Ensure accurate and complete account follow-up by demonstrating a thorough understanding of carrier-specific reimbursement as applicable to claim processing to include: benefits and coverage according to specific carrier, UB92 claims form preparation

  • Work any assigned correspondence related to assigned accounts

  • Document all activity taken on an account in the patient account notes

  • Conducts appropriate account activity on accounts by contacting government agencies, third party payors, and patients/guarantors via phone, e-mail, or online.  Continue collection activity until account is resolved

  •  Responsible for maintaining inventory and that daily productivity standards of assigned accounts are met

  • Request additional information from patients, medical records, and others upon request from payors

  • Review payer contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed

  • Updates Plan IDs and Patient/Payor demographic information; document notes to accounts

  • Identify payor issues and trends and escalate issues to Management

  • Ensure compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors

 KNOWLEDGE, SKILLS, ABILITIES:

  • Must be able to communicate effectively and professionally with strong attention to details and problem solving both verbally and written

  • Strong telephone communications skills are required

  • Ability to prioritize work and meet deadlines is required

  • Knowledge of general office procedures is required

  • Ability to operate common computer systems, utilize hospital collection system and business software is required

  • Intermediate understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements

  • Intermediate knowledge of hospital billing form requirements (UB-04)

  • Intermediate understanding of ICD-9, HCPCS/CPT coding and medical terminology, understanding of ICD-10 a plus

  • Intermediate Microsoft Office (Word, Excel) skills

  • Advanced business letter writing skills to include correct use of grammar and punctuation

  • Understanding of the revenue cycle process

  • Strong interpersonal skills

  • Above average analytical and critical thinking skills

  • Ability to make sound decisions

  • Has a full understanding of hospital collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements.

  • Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims

  • Intermediate understanding of EOB, hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms

Education/Experience: 

  • High School Graduate minimum education requirement

  • Medical collections experience preferred

  • Strong analytical skills and strong proficiency in Microsoft Office Tools

  •  Some college coursework in business administration or accounting preferred

  • 2-3 years medical claims and/or hospital collections experience

Location:  TX-Plano

Job Type:  Full Time – days