Tandem Hospital Partners

Medical Billing Specialist

US-TX-Houston
Job ID
2017-1211
# of Openings
1
Category
Customer Service/Support
Corporate Office

Overview

Tandem Logo

 

Tandem Hospital Partners works with leading hospital systems across the U.S. to build and operate state-licensed, CMS-accredited, acute care neighborhood hospitals.  These next-generation hospitals offer convenient, 24/7 neighborhood access to high quality, compassionate emergency and inpatient care, offering low wait times and an exceptional patient experience.

 

Tandem’s strong clinical, retail, and hospital experience establishes us as the preferred partner in this emerging, innovative industry segment with the most experienced, collaborative, values-driven leadership team.  By partnering with Tandem, hospitals can meet the growing demand for emergency and inpatient services in communities where they are currently underrepresented, providing more convenient access to high quality, integrated and patient-centered care.

 

Job OpportunityMedical Billing Specialist

Responsibilities

Essential Functions

  • Uphold the values and standards of the Tandem Hospital Partners Family
  • Responsible for billing all patient claims in a timely manner
  • Prepares, reviews and sends patient statements
  • Evaluates patient’s financial status and establishes budget payment plans. Follows and reports status of delinquent accounts to Manager
  • Identifies and resolves patient collection complaints
  • Ability to learn new computer applications quickly and independently and become a skilled user of the company’s or JV partner’s proprietary database
  • Participates and attends monthly staff meetings
  • Maintains PHI and HIPPA patient confidentiality standards for medical and financial information
  • Contribute to team environment by performing other duties as assigned
  • Prepares and submits clean claims to various insurance companies either electronically or by paper

  • Knowledge of physician (CMS-1500) and facility billing (CMS-1450/UB-04)

  • Reviews claims issues, makes corrections as needed and rebills. Utilizes claims clearinghouse to review and correct claims and to resubmit electronically as needed

  • Daily review of all postings before claim submission

  • Daily closing and balancing of day posted

  • Responsible for evaluating bill cycles and changing/updating when necessary

  • Responsible for providing daily billing reports – both electronic and paper claims. Monitor validation percent

  • Responsible for reviewing claim (837 EDI Health Claims & Equivalent Encounter Information) files receipt and response reports

  • Maintain billing files/records by batch in accordance with established protocol

  • Work daily claims rejection lists in billing software and clearinghouse queues; set claim(s) to rebill as needed

  • Answers questions from patients, clerical staff and insurance companies

  • Identifies and resolves patient billing complaints

  • Prepares, reviews and sends patient statements

  • Evaluates patient’s financial status and establishes budget payment plans. Follows and reports status of delinquent accounts to Manager

  • Maintains strictest confidentiality; adheres to all HIPAA and PHI guidelines/regulations

  • Meets all month end closing processes to ensure billing is completed on a timely basis

  • Participates and attends monthly staff meetings

Qualifications

Minimum Qualifications

  • Knowledge of filing deadlines for government and commercial payors
  • High school diploma or equivent
  • Minimum 2+ years of Medical Billing experience
  • Certified Professional Biller (CPB) thru American Academy of Professional Coders preferred
  • Certified Medical Insurance Specialist (CMIS) thru Practice Management Institute preferred

 

Knowledge, Skills and Abilities

  • Advanced computer skills including Microsoft Office; especially Word, Excel, and PowerPoint
  • Knowledge of office administration procedures with the ability to operate most standard office equipment
  • Knowledge of medical billing practices
  • Knowledge of basic medical coding and third-party operating procedures and practices
  • Ability to operate a multi-line telephone system
  • Skill in answering a telephone in a pleasant and helpful manner
  • Ability to read, understand and follow oral and written instructions
  • Some knowledge of CPT, HCPCS and ICD-10 codes
  • Basic understanding of medical terminology and physiology
  • Knowledge of online carrier websites/portals
  • Knowledge of CMS-1450/UB-04 and CMS-1500 claim forms
  • Explanation of Benefits interpretation
  • Ability to adapt to various billing computer systems in a fast paced environment
  • Familiarity with Medicare LCDs and commercial payor Clinical Policy Bulletins
  • Familiarity with NCCI (National Correct Coding Initiative) edits
  • Ability to work professionally with sensitive, proprietary data & information while maintaining confidentiality
  • Self-motivated with strong organizational skills and superior attention to detail
  • Must be well organized and detail oriented
  • Customer service orientation
  • Must be able to manage multiple tasks/projects simultaneously within inflexible time frames
  • Ability to adapt to frequent priority
  • Accuracy a must

Location

Downtown, Houston, TX

 

Travel Required

Up to 25% depending business needs

 

Eligibility Requirements

If you are applying for a position in the United States, you must be at least 18 years of age, legally authorized to work in the United States, and not require sponsorship for employment visa status (e.g. TN, H1B status), now or in the future.

Tandem Hospital Partners strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. THP is proud to be an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, age, disability, Veteran status, gender identity or expression, genetic information or any other legally protected status. We maintain a drug-free workplace and perform pre-employment substance abuse testing.

 

The essential functions listed are typical examples of work performed by positions in this job description and are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Specific duties and responsibilities may vary depending on department or program needs without changing the general nature and scope of the job or level of responsibility. Employees may also perform other duties as assigned.

 

Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

as well as possession of any required licenses or certifications is qualifying.

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