Reimbursement Other

The Reimbursement Clerk works under the direction of the Director of Reimbursement. This position is responsible for the follow-up and posting of payments for Medicare, Medicare Advantage Plans, Medicaid MCOs, Foster Care, CHIP, Commercial Insurance and Consumer Payments. This position is required to work with Accounting Staff and Reimbursement Specialist to conduct month end payment reconciliation. This position is responsible for inquiring and placing Reimbursement Department supply orders on a monthly bases. This position will work with the Director of Reimbursement/ CFO on special projects and is appointed to the Reimbursement Committee. This position will require some travel throughout the local service area, therefore, adherence to Center driving qualifications and access to a personal vehicle are requisites. This position is based in Howard County. 

Salary:$ 15.72

1.Responsible for posting of Medicare, Medicare Advantage Plans, Medicaid MCOs, Foster Care, CHIP, Commercial Insurance and Consumer payments.

• a)All payments will be posted within 48 hours of receiving.
• b)All payments will be posted by the 10th of the following month.
• c)The appropriate auditing process will occur during the posting process. 
• d)All audit findings will be reported to the Director of Reimbursement.

2.Responsible for working with the Appeals and Collections Coordinator in identifying all denials for MH Claims.    

• a)All denials received will be entered in during posting process.
• b)Denials are to be coded correctly so that they can be reviewed by the Appeals and Collections Coordinator

3.Assist in the development, completion and distribution of policies and procedures for the Reimbursement Department.

• a)Meets with appropriate staff when developing policies and procedures.
• b)Reviews all policies and procedures to ensure they comply with all Medicaid, Performance Contract and other regulations. 

4. Completes and distributes the ?Late Services? report.  

• a)Compiles a late service report weekly
• b)Distributes information to the appropriate people weekly.

5.Compiles and places all Reimbursement Office supply requests. 

• a)Communicate with Reimbursement team members to collect and place office supply requests monthly via Microix software.

MARGINAL TASKS & PURPOSES

1.Performs related duties and  administrative task as assigned. 

• a)Carries out assignments as requested by Director of Reimbursement/ CFO demonstrating a pattern of successful completion of work as assigned and evidenced by timely submission and achievement of desired outcomes. 

2.Participate as a member of all committees as assigned and participates in Anasazi and Medicaid Consortium Meetings. 

• a)Attend all meetings as scheduled or inform supervisor in a timely manner if unable to attend.
• b)Share information gained in meeting with supervisor and all appropriate staff.
• c)Complete assignments in specified time frame

ESSENTIAL WORK BEHAVIORS:

All employees are expected to comply with all West Texas Centers (WTC) Policies and Procedures. This includes but is not limited to the following:

• WTC Code of Conduct Policy and reporting requirements
• WTC Corporate Compliance Policy, related procedures and reporting requirements
• Abuse, Neglect & Exploitation Policy and reporting requirements
• Standards for Employees Policy
• Property and Equipment Policies and related procedures

Staff will establish and maintain effective work relationships with individuals served and their families, supervisors, co-workers, and visitors by demonstrating cooperative, courteous, and respectful behavior. Staff will adhere to rules outlined in Confidentiality Statement signed by employee and follow Information Services policy/ procedure guidelines related to security and accountability as a user of WTC network and software application technology.

All team members will promote and ensures safety guidelines are followed for the work environment by maintaining clean, neat, organized and safe work areas. This includes but is not limited to the following:

• Safety concerns are reported to supervisor immediately upon discovery and/or corrected.
• Identifies and reports any unsafe factors in the environment.
• Reports and/or corrects safety hazards in the work area.
• Utilizes universal precautions when handling all blood and body fluids.
• Adheres to all standards, policies and procedures of infection control.
• Universal precautions are utilized in accordance to WTC policy and procedures.

Team Members must have and maintain a driving record that is acceptable for insurability through the Center's insurance carrier.  Staff must maintain a safe, inspected and road-worthy vehicle and have a valid Texas Driver's License. Staff must notify supervisor immediately of any driving violations or citations received from law enforcement with no evidence of failure to report. Must meet the criteria that indicate a commitment to safe and responsible driving as defined by the Texas Risk Management Fund.