Regional Claims Manager jobs in Round Rock, TX

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. We offer the following benefits to eligible team members: 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 visit https://www.austinregionalclinic.com/careers/

PURPOSE

Responsible for processing follow up actions on denied, unpaid and/or underpaid insurance claims, and responding to health plan correspondence primarily in Contract Manager. Carries out all duties while respecting patient confidentiality and promoting the mission and philosophy of the organization supported.

ESSENTIAL FUNCTIONS

• Contract Manager

  • Identifies areas of opportunity for under payments, overpayments, or contract updates.
  • Generates and submits individual or mass appeals, creates appeal letters and/or works with payer representative to submit appeal projects.
  • Tracks appeals and recoveries and performs regular follow up on outstanding appeals.
  • Reports possible contract and payer discrepancies and/or recommends contract record updates as necessary.
  • Communicates payer contracting/fee schedule issues impacting claims to CBO management.
  • Serve as point of contact for fee schedule allowed amount inquires.
  • Submit Experian support cases regarding contract record or claim valuation inquires.
  
  

  
  Epic Claims Follow up

  • Reviews and edits claims in follow-up work queues as necessary to reflect complete, accurate information.
  • Utilizes In-Basket to communicate with clinic staff and obtains information and authorization to edit claims.
  • Reviews procedure and diagnosis codes to make sure they conform to third party rules and ensure highest possible appropriate reimbursement.
  • Researches insurance payments and ANSI Reason Code denials to determine correct posting information.
  • Follows up with insurance carriers on problem payments and adjustments.
  • Utilizes Payer/Storage web-sites for claims status or eligibility.
  • Opens, closes, and processes batches according to departmental guidelines.
  • Generates any adjustments necessary to complete posting of payments.
  • Uses appropriate functions when performing actions as described through Account Maintenance.
  • Maintains and follows up on accounts appropriately and documents all activities and results through Account Contact.
  • Reviews accounts for credits and request refunds to Insurance Companies or Patients as necessary.
  • Obtains signature of approval for any adjustments 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.
  
  

  
  Work Queue Maintenance

  • Reviews claims for research and follows-up on accounts as assigned in the follow up work queues.
  • Manages accounts assigned to the work queues using Work Queue Ticklers.
  • Documents all account activities and results in Account Contact.
  
  

  
  Correspondence

  • Ensures correspondence is managed within seven (7) calendar days.
  • Posts zero payment EOBs / correspondence by way of a payment posting batch
  • Reviews work queue summary for each correspondence account and completes work queues as appropriate.
  • Responds to patients to confirm receipt of and/or provide resolution to written correspondence.
  
  

  
  Registration

  • Forwards requests for registration verification and sends updates to the registration department.
  
  

OTHER DUTIES AND RESPONSIBILITIES

• Processes claims in Epic Account Maintenance.
• Provides call-center back-up to customer service and registrations departments.
• Meets performance standards in Patient Registration and Posting.
• Keeps files complete, accessible, and updated.
• Verifies insurance eligibility and sets up accounts by account type classifications.
• Provides assistance to coworkers as requested and/or necessary.
• Provides workload statistic reports to management team.
• Responds professionally and effectively to questions from external sources, i.e., customer or carrier, and internal sources (provider or management team).
• Attends required in-services/training sessions.
• Works overtime when requested by unit/department/clinic procedures.
• Follows rules and regulations of Covenant Management Systems as described in the employee handbook and in the unit/department/clinic procedures.
• Performs other duties as assigned.
• Has consistent and dependable attendance.

QUALIFICATIONS

Education and Experience

Required: High school diploma or equivalent. At least five or more years of experience in professional billing, payment posting, and claim denial resolution. At least 2 or more years of experience working with accounts receivables to include effectively pursuing payments from carriers and customers.

Preferred:Knowledge of CMS/ARC billing & collections functions. Experience with Epic billing and registration modules.

Knowledge, Skills and Abilities

• Strong computer skills (proficiency in Microsoft Word and Excel and 10-key entry).
• Excellent customer service skills.
• Knowledge of and/or experience with billing and collecting from Medicare, Medicaid and commercial insurance.
• Knowledge of and/or experience with procedural and diagnostic coding.
• Knowledge of patient copay vs. cost share responsibility.
• Basic knowledge of insurance contracts and fee schedules.
• Knowledge of legislative and private sector third party regulations and guidelines.
• Excellent verbal and written communication skills. Excellent interpersonal & problem solving skills.
• Ability to work in a team environment.
• Strong analytical and problem solving skills.
• 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 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 communicate factual 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