Reimbursement Specialist III

Department: 8031 - Reimbursement
Location: 6800 Park Ten Blvd
San Antonio, TX, 78213
Salary Range: $37, 294.00 - $55,941.00 Per Year
Work Schedule: Monday - Friday 8:30 am 5:30 pm

The Reimbursement Specialist III is responsible for all phases of insurance payment processes, to include appeals and reconciliations, and recalculate client service listing for billing.


TASKS

  1. Responsible for all phases of insurance payment processes, payments, denials and appeals, processing, tracking and reconciling reimbursement (payment) from Carelink & Client Fee

  2. Provide highly technical third party billing work in the maintenance of reimbursement operations, procedures and controls in compliance with internal and external regulations (e.g. National Heritage Insurance Co, Medicaid, Medicare) and procedures

  3. Manage assigned Accounts Receivable by unit# for Carelink and assigned alphabet for other insurance

  4. May enter client authorization for external providers received from the Client Data Department

  5. Receive client service listing (from eligibility effective date) from Reimbursement Specialist II staff for recalculation and billing according to Payors claim filing deadline

  6. Responsible for the preparation and process for all third party billings; verify required information for billing. Billing includes Medicaid, Medicare, funding contracts, private insurance, and private pay

  7.  Responsible for performing complex, technical, and administrative work involving maintenance of Texas Home Living (TxHmLv) and Home Community-Based (HCS) consumer accounts and billing

     

     

  8. Responsible for entering all HCS and TxHmL services notes billing logs into the CARE system

  9. Provides assistance to out-stationed staff in the entry of authorizations into the system

  10. Reconciles all forms onto a cumulative spreadsheet for reconciling with the account receivables (A/R)

  11. Maintains a detailed spreadsheet system for reporting HCS & TxHmL consumer services tracking of revenue and provides summary report to the Accounting Department on a weekly basis for agency budget reports

  12. Assists with entry and/or review of Medicaid Management Care Organization authorizations

  13. Provide technical assistance to program staff as necessary

  14. Performs other related duties as required

 

MINIMUM REQUIREMENTS

  1. High School Diploma or GED

  2. Three to five (3 – 5) years’ of billing experience in medical services environment

  3. Proficiency with standard Microsoft Office applications and system databases

  4. Experience with telephone, fax machine, copy machines, calculator, and other office machines, and accessing information utilizing the Internet to analyze, retrieve, and forward data

  5. Must maintain required credentials and mandatory training requirements to ensure compliance with all State regulations and CHCS policies

  6. Must maintain a valid driver’s license and automobile insurance coverage, be able to travel as needed, and be able to meet on a consistent basis the driving record requirements of the Company’s auto insurance carrier if you drive your vehicle during company business

  7. Must be able to meet the physical requirements to complete SAMA and CPR training including lifting up to 12 lbs. and supporting up to 55 lbs.; bending, stooping and getting on and off the floor without assistance.

  8. Must have adequate mobility that requires frequent walking, standing, bending, stooping, kneeling, reaching (vertical and horizontal), using fingers, hands, feet, legs and torso in various care. The employee must be able to regularly lift and/or move up to 40 pounds and occasionally must lift and/or move up to 50 pounds. The employee must be able to occasionally transfer a consumer.

 

PREFERRED

1. Bilingual (English/Spanish)

 

Physical Requirements/Demands = 2

1 = Primarily Direct Patient Care
2 = Primarily Office Work
3 = Primarily Physical Work

 

Compensation Package

Salary Range: Min $37,294.00 – Max $55,941.00 

Recruiting and retaining talented individuals is important to us. At the Center for Health Care Services, we are committed to providing our employees with a total compensation package that includes competitive pay, affordable health and wellness benefits, generous paid time off, flexible work schedules, professional development opportunities and generous retirement savings options.

We have wide range of career opportunities and hope you will join us in our mission!

Apply online today at: www.chcsbc.org

The Center for Health Care Services is an Equal Opportunity Employer