Patient Account Specialist Lead - TLRA Insurance

DescriptionSummary: Provides medical collection services for TLRA collection units. Utilizes a strong background as a medical collection specialist to successfully resolve accounts placed with TLRA for collection. This involves performing collection activities related to follow-up and account resolution and includes communication with patients, clients, reimbursement vendors, and other external entities while adhering to all client, state, and federal guidelines. Patient and client satisfaction is essential. Associates in the collection units are expected to knave knowledge of the overall collection work processes for both active AR and BD inventory. Responsibilities: Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.Provides effective collection services, ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA’s business objectives.Understands and adheres to all policies and procedures, as well as local, state, and federal regulations, relevant to their area of operation.Documents and updates patient account information in TLRA’s collection software system timely and accurate to include appropriate account status.Handles inbound patient and/or carrier calls promptly and professionally, providing assistance and resolution to account inquiries, issues, and request.Uses collection tools effectively to ensure quality recovery services and meet or exceed established goals and work standards.Performs research and analysis of account issues and strives to resolve problems timely and accurately.Ensure daily productivity standards are met.Promotes positive patient relations by communicating in a manner that demonstrates respect for the human dignity of patients and/or their families.Thorough understanding of Medicare/Medicaid guidelines and procedures for billing, collections, and appeals.Understanding and exposure to Medicare Recovery Audit Contractor.Knowledgeable in locating and referencing CMS and/or Medicare Regulations.General hospital A/R accounts knowledge is required.Solid knowledge and utilization of desktop applications including Word and Excel are essential.Performs other special projects as required when assigned. Collections – Traditional Government Insurance Maintains active knowledge of all collection requirements by payors.Collects balance owing from third-party payers in accordance with State and Federal laws governing collections practices. Ensures that collection efforts are thorough with the overall objective being to collect outstanding balances in an ethical manner.Ensures established quality standards are met and proper documentation regarding patient accounting records.Contact other departments to obtain necessary information for appeals, pending information, and any other issues that impact and/or delay claim processing.Provides effective and timely collection services ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA’s business objectives.Validates claim payments to ensure claims are paid according to contract and/or payment methodology guidelines.Correct claims in RTP status in either CCSM or DDe per Medicare guidelines.Initiate Medicare Redetermination, Reopening, and/or Reconsideration as needed. Job Requirements: Education/Skills High School or equivalent years of experience required. Experience 5 – 7 years of experience preferred. Experience with the Medicare billing process. College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience. Licenses, Registrations, or Certifications None required. Work Schedule: 5 Days - 8 Hours Work Type: Full Time EEO is the law - click below for more information:  https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at (844) 257-6925. Additional Information: - Specialty: Billing and Insurance Specialist - Location: 2900 North Loop WestHouston, Texas 77092 - Contact: About the Company: CHRISTUS Health is an international Catholic, faith-based, not-for-profit health system comprised of more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. Sponsored by the Sisters of Charity of the Incarnate Word in Houston and San Antonio and the Sisters of the Holy Family of Nazareth, the mission of CHRISTUS Health is to extend the healing ministry of Jesus Christ. To support our healthcare ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on staff who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States. EXTENDING THE HEALING MINISTRY OF JESUS CHRIST We are inspired by our mission, vision and core values to deliver compassionate, high quality health care, improving the health of the communities we serve. Above all, we are committed to providing our customers and their family members with a truly unique healing experience, one that embodies our values and respects the dignity and worth of each person. Creating a health care system that is truly excellent in all areas is an ongoing effort.