RCM - Specialty Follow Up

We’ve learned that what is best for patients is also best for employees. Learn more about why we are one of the Best Companies to Work for in Texas®. ________________________________________________________________ In 2020 and again in 2021, UMC Physicians has received the 1st place ranking as “One of the Best Companies to Work for in Texas®” by the Best Companies Group. Summary Title: RCM Specialty Follow Up Department: Central Business Office We are seeking a full-time team member with a passion for others to work at UMC Physicians. We want people who bring strong customer services skills and a desire to take on the challenges in front of them. We offer positions and growth opportunities to help you get to where you want to go. Preferred Characteristics: • Goal oriented • Professional demeanor and appearance • Punctual and dependable • Problem solving and critical thinking abilities • Teamwork • Organization and time management, ability to multi-task and meet deadlines Availability Requirements: • Ability to work 40 hours per week • 8-5 Monday – Friday Our Mission: To improve the quality of life for our community by providing the best patient experience for every patient. Our Vision: To be the best place to work and the best place to receive healthcare. Benefits: UMC Physicians offers a comprehensive benefits package to eligible full-time employees. Benefits include: • Paid Time Off • Sick Pay • Medical, Dental and Vision Insurance • Employer Paid Group Life and Voluntary Life Insurance • Short Term Disability Insurance • Long Term Disability (after 2 years of employment) • Critical Illness, Accident and Cancer Insurance • Health Care and Dependent Care Spending Accounts • 401K Retirement Plan with Company Match • Employee Assistance Program Note: Some benefits require an employee contribution to participate. Job Summary: The Revenue Cycle Management Specialty Follow Up position is responsible for ensuring accurate and timely submission of insurance claims, obtaining missing information, researching denials and documentation, following up on claims, and maintaining compliance with department standards, HIPAA, and governing agency policies and procedures. This position also ensures all initial third party and federal/state government claims are billed and all unpaid, rejected or denied claims receive appropriate follow up or an appeal to over-turn the denial as required. Accurately and timely preparation and submittal of corrected claims to payers via electronic (837) or paper is also required. The RCM Specialty Follow up position must take action required to resolve rejected, underpaid and denied claims by submitting corrected claims and appeals on a timely basis upon review of unpaid encounters. They must also identify and resolve complex claims issues adversely impacting the revenue cycle and achieve resolution through coordination with clinical departments and the payer. This position works closely with the Central Billing Office Administration, clinical practice mangers, billers, and coders. Skills and Abilities: • Requires knowledge of carrier specific claims appeal guidelines to includes claim logic, internet, and paper/fax processes. • Requires proven analytical and decision making to determine what selective clinical information must be submitted to properly appeal the denial. •Requires proven knowledge of CPT and ICD-10 coverage policies, internal revenue cycle coding processes and the billing practices of the specialty service line • Requires clear and concise written and oral communication with payors, providers, and billing staff to ensure resolution of denials. • Requires the ability to read and interpret E&M notes, complex diagnostic study results, endoscopic and interventional results and/or major surgical operative notes. • Determine appropriate action for denial resolution based on documentation • Requires proven knowledge of the specialty specific service line documentation requirements. Minimum Qualifications: • High School diploma or equivalent • Two (2) years medical billing or collections required (combination of higher education and experience may be considered to satisfy years of experience requirement) • Medical terminology • Type 40wpm, 10 key by touch • Strong analytical and critical thinking Preferred qualifications: • CPC OR CPC-A • Knowledge of Medicare, Medicaid, and Commercial Insurance procedures • Denial management, billing/coding guidelines • Experience in Cardiothoracic, Gastrointestinal, Neurology, Anesthesiology, or Allergy specialties. Environmental Conditions: Works in well-lighted, heated and ventilated building. Exposure to blood borne pathogens are of low risk. Hours of duty may be irregular. Physical Requirements: Requires prolonged sitting, some bending, lifting, stooping, and stretching. Hand-eye coordination and manual dexterity sufficient to operate a keyboard, copier, telephone, adding machine, fax machine, printers and other minor office equipment is a must. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Must also be able to communicate in person, via voicemail, vie email and on the telephone. Limitations and disclaimer: The above job description is meant to describe the general nature of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position. This position is security sensitive ___________________________________________________________ UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. *Request for accommodations in the hire process should be directed to UMC Human Resources.* Benefits: Resilience program Emotional Physical Spiritual Financial Career Community On-Site Professional Counselors (EAP) Discounted Pharmacy Cost Cash Retention Bonus (only one in our region) Retirement Benefits w/Employer Match PTO & Extended Illness Medical, Dental, & Vision Insurance And more at: https://apps.umchealthsystem.com/documents/wellness.pdf UMC Vision, Mission and Standards: Vision: To Serve Our Patients in the Best Teaching Hospital in the Country Mission Statement: Service is our passion. We serve by providing safe, high quality care to all, achieving excellent financial performance, and training tomorrow’s healthcare professionals. Standards of Excellence: Attitude, Communication, Responsiveness, Compassion, Teamwork, Ownership, Safety and Respect About UMC Magnet Designated 501 licensed beds 62 Site locations Regions only Level I Trauma Center Regions only BICU DNV accredited Primary teaching hospital for the Texas Tech University Health Sciences Center (TTUHSC) Ranked as one of the Best Places to Work in Texas by Texas Monthly UMC Physicians Culture, Vision, Mission, and Standards: Culture: Service is Our Passion Vision: The best place to work and the best place to receive healthcare. Mission Statement: To improve the quality of life for our community by providing the best patient experience for every patient. Standards: Teamwork, Respect, Accountability, Compassion, Kindness About UMCP 35 Practice Locations – private practices and urgent care centers Over 125 physicians and advanced practice providers Ranked as “One of the Best Places to Work in Texas” by Texas Monthly Employee Engagement Score of 96% measured by Press Ganey Associates