Reimbursement Operations Specialist (SOD-DB Patient Services)

UT Health

Houston, TX, USA

Full time

Nov 8

Ensures that billable patient charge documents have been correctly coded with standardized coding conventions to obtain optimum reimbursement.

This position will requier the candidate to be a self-starter with a can-do, innovative and forward-thinking mindset; highly adaptable to new knowledge/skills in a fast-paced environment; meticulous attention to detail. Posess knowledge and understanding of insurance benefit plans, claims processing, Explanation of Benefits (EOB). Experience in general Revenue Cycle processes; Proficiency in EMR/EHR systems and software applications, i.e. Microsoft Office, especially Excel. Strong critical thinking and conflict resolution skills; ability to work independently without close supervision. Excellent interpersonal, organizational, verbal and written communication skills.

Position Key Accountabilities:

  1. Reviews insurance company documents to ensure accuracy of reimbursement.
  2. Monitors charges/reimbursements to optimize collection process.
  3. Interfaces with Medicare, Medicaid, and/or insurance companies to handle various problems.
  4. Analyzes fee structures to ensure professional fee billings.
  5. Stays abreast of coding procedures in order to utilize state-of-the-art methods of accurate reimbursement.
  6. Trains various personnel in billing procedures.
  7. Other duties as assigned.

Certification/Skills:

Minimum Education:

High School diploma or equivalent.

Minimum Experience:

Two years of directly related experience in area of specialty.

Physical Requirements:

Exerts up to 50 pounds of force occasionally and/or up to 20 pounds frequently and/or up to 10 pounds constantly to move objects.

Security Sensitive:

This job class may contain positions that are security sensitive and thereby subject to the provisions of Texas Education Code § 51.215

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UT Health

Houston’s health university since 1972.

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