Insurance Biller

At Houston Methodist, the Insurance Biller position is responsible for processing all billing related functions within the Centralized Business Office (CBO). This includes, but is not limited to, resolution of charge review (where applicable) and claim edits, payor rejections, unresolved or no response insurance claims and processing of financial correspondence. The Insurance Biller demonstrates general knowledge of billing practices and maintains departmental standards relating to insurance claims processing, charge entry and billing functions. This role is also responsible for providing support to other departments within the CBO related to billing functions, including communicating claim issues to departmental management for further discussion with payor representatives and other key stakeholders as needed and as applicable.
PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity. HOUSTON METHODIST EXPERIENCE EXPECTATIONS Provide personalized care and service by consistently demonstrating our I CARE values: INTEGRITY: We are honest and ethical in all we say and do. COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs. ACCOUNTABILITY: We hold ourselves accountable for all our actions. RESPECT: We treat every individual as a person of worth, dignity, and value. EXCELLENCE: We strive to be the best at what we do and a model for others to emulate. Practices the Caring and Serving Model Delivers personalized service using HM Service Standards Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words) Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience. Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job Displays cultural humility, diversity, equity and inclusion principles Actively supports the organization's vision, fulfills the mission and abides by the I CARE values PEOPLE ESSENTIAL FUNCTIONS Provides support for the revenue cycle departments (as applicable: payment posting, coding and accounts receivable (AR) follow up) related to administrative duties as needed. Collaborates with the revenue cycle teams to follow up on missing data that may delay claims submission and payment. Collaborates with internal CBO department and Account Managers to identify and prevent claims processing errors. Assists with knowledge sharing, payor and department training, and provides support to other team members as advised by the manager and/or supervisor. Resolves routine insurance billing inquiries and problems within departmental standards. SERVICE ESSENTIAL FUNCTIONS Follows established departmental workflows within the electronic health record system appropriate work queues in response to correspondence/reports/data/requests received. Processes financial/insurance correspondence received associated to billing functions. Pulls explanation of benefits when requested or as needed to file secondary claims. QUALITY/SAFETY ESSENTIAL FUNCTIONS Meets departmental productivity and quality standards. Completes claim edits timely, compliantly, and without errors. Documents clear, concise and complete notes in system for each account worked. Identifies claim processing issues and general billing trends. Notifies supervisor and/or manager regarding trends to avoid further delay in claims processing. Demonstrates understanding of fundamentals of all payors, including Medicare, Medicaid and commercial payors, and applicable revenue cycle operations. Maintains strict confidentiality of patients, employees and hospital information at all times. Ensures protection of private health and personal information. Adheres to all Health Insurance Portability and Accountability Act (HIPAA) and Payment Card Industry (PCI) compliance regulations. FINANCE ESSENTIAL FUNCTIONS Ensures claims are submitted within payor deadlines and reports barriers to claim submission to management. Completes billing functions within established departmental standards including billing related work queues and workflows to ensure claims are billed accurately, compliantly, and timely. Resolves basic edits, rejections, and unresolved/no response insurance claims. Processes actions to resolve clearinghouse billing, rejections, and eligibility related errors to ensure timeliness of charge/claim submission. Monitors and processes all `no response' claims for timely resolution of services within established work queues. Where applicable, submits accurate adjustments based on billing guidelines and departmental policies, contract requirements, or levels of authority. GROWTH/INNOVATION ESSENTIAL FUNCTIONS Remains current on billing guidelines and regulations of various payors and/or specialty practices as directed by the supervisor and/or manager. Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development. This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
EDUCATION High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.) WORK EXPERIENCE Two years of professional or hospital billing experience, as applicable to the department LICENSES AND CERTIFICATIONS - REQUIRED N/A KNOWLEDGE, SKILLS, AND ABILITIES Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles Working knowledge of professional fee insurance requirements Familiarity with general International Classification of Disease (ICD) and Current Procedural Terminology (CPT) coding, payor filing deadlines, and electronic data elements required for clean claim submission Ability to be self-motivated, detail oriented, and work independently with minimal supervision Proficient computer skills and ability to learn and navigate multiple software programs SUPPLEMENTAL REQUIREMENTS WORK ATTIRE Uniform No Scrubs No Business professional Yes Other (department approved) No ON-CALL* *Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below. On Call* No TRAVEL** **Travel specifications may vary by department** May require travel within the Houston Metropolitan area No May require travel outside Houston Metropolitan area No Houston Methodist (HM) is one of the nation's leading health systems and academic medical centers. HM consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston metropolitan area. HM also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities. Overall, HM employs over 25,000 employees. Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.
In 2019 Houston Methodist and its physicians treat more than 6,333 international patients from more than 76 countries. Houston Methodist Global Health Care Services' consulting and education divisions also provide advisory services and training and development to health care organizations around the world.