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Location

Arlington, TX | United States

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Job description

Responsibilities

Come and join the RMC Family! 

We have been in the community since 1935.  Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region.  Your passion, inspiration, and talents are invaluable to us and our mission to serve others.  Our facility can provide a place for you to thrive and continue your professional development.  Quality Healthcare is our passion, improving lives is our reward.  We are working to change lives and transform the delivery of healthcare. Riverside Medical Clinic is the best place to work, practice medicine, and receive care.

SUMMARY: To provide timely and accurate claims status information to providers, members, health plans, or other customers in need of assistance. Act as liaison between providers, HMO’s, members and the claims unit in order to establish and maintain professional relationships between all parties. Update HMO member coverage records in the Epic system based on the monthly encounter error report.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must have knowledge using Microsoft Word, Excel and Access software programs.

HOURS: Monday- Friday 7:30AM- 4:00PM

Qualifications

EDUCATION and/or EXPERIENCE: High school diploma or general education degree (GED); or 2 or more year’s claims processing experience and/or training; or equivalent combination of education and experience.

CERTIFICATES, LICENSES, AND REGISTRATIONS: None.

ESSENTIAL FUNCTIONS:
Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Note: (other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing).

1. Uphold and support the philosophy, objectives, Code of Conduct and policies of Riverside Medical Clinic.
2. Assume responsibility for initiating a pleasant service-oriented atmosphere by displaying a professional attitude through performance, appearance, and demeanor.
3. Maintain work area in a clean and orderly manner.
4. When messages from providers, patients or health plans are left on the customer service audix the calls will be returned within 48 hours of receipt.
5. When speaking with a customer, should additional information or research required to be able to give a correct response to the customer, inform the caller you will return their call with the information within 48 hours of receipt. Schedule the return call directly on the calendar in Outlook.
6. Document all claim inquiry calls coming in to Tapestry in CRM for call tracking and follow up daily.
7. Sort claim inquiries in order of priority and submit them to the Claims Supervisor for review. The Supervisor will determine the level of priority processing and forward appropriately.
8. Act as liaison between the providers, HMO’s, members and claims unit in order to establish and maintain professional relationships between all parties.
9. If the claim was processed before and the caller is appealing the original decision, this is not a dispute it is a “claim inquiry”, and the claim will be handled as a priority, and forwarded to the Claim Supervisor.
10. If a provider states they previously sent in a written dispute, there will be notes in the claim system identifying it as such. Only then will the Provider Dispute Auditor become involved and address the concern directly with the caller.
11. When claims cannot be processed or completed due to missing information, request additional information from providers, when needed.
12. Calendar for follow up on all customer service claims forwarded to the examiner to ensure they are processed in accordance with regulatory and departmental requirements. As a courtesy to the provider contact will be made notifying them of the decision.
13. Verify the patient accounts, eligibility and authorizations were correct when original claims were processed. Determine if a balance due or denial is required and communicate this to the Claims Supervisor and/or Provider Dispute Auditor.
14. Prepare and print provider labels for mailing zero payment EOB’s to providers receiving a denial or request for resubmission of a corrected claim. EOB’s are to be mailed before the close of business every Friday afternoon.
15. As a back-up to the clerk, will assist the Director with preparation of documentation, claims, acknowledgements, EOB’s, checks, denial letters and Provider Disputes for HMO Health Plan claim audits, as needed.

16. Other duties as assigned by management.

This opportunity offers the following:

Challenging and rewarding work environment
Growth and Development Opportunities within UHS and its Subsidiaries
Competitive Compensation

One of the nation’s largest and most respected hospital companies, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Steadily growing from a startup to an esteemed Fortune 500 corporation, UHS today has annual revenue nearing $10 billion. In 2017, UHS was recognized as one of the World’s Most Admired Companies by Fortune; ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of America’s Top 500 Public Companies.

Our operating philosophy is as effective today as it was 40 years ago: Build or acquire high quality hospitals in rapidly growing markets, invest in the people and equipment needed to allow each facility to thrive, and become the leading healthcare provider in each community we serve.

Headquartered in King of Prussia, PA, UHS has more than 81,000 employees and through its subsidiaries operates more than 320 acute care hospitals, behavioral health facilities and ambulatory centers in the United States, Puerto Rico, the U.S. Virgin Islands and the United Kingdom.

*UHS is a registered trademark of UHS of Delaware, Inc., the management company for Universal Health Services, Inc. and a wholly-owned subsidiary of Universal Health Services, Inc. Universal Health Services, Inc. is a holding company and operates through its subsidiaries including its management company, UHS of Delaware, Inc. All healthcare and management operations are conducted by subsidiaries of Universal Health Services, Inc. To the extent any reference to "UHS or UHS facilities" on this website including any statements, articles or other publications contained herein relates to our healthcare or management operations it is referring to Universal Health Services' subsidiaries including UHS of Delaware. Further, the terms "we," "us," "our" or "the company" in such context similarly refer to the operations of Universal Health Services' subsidiaries including UHS of Delaware. Any employment referenced in this website is not with Universal Health Services, Inc. but solely with one of its subsidiaries including but not limited to UHS of Delaware, Inc.

UHS is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at UHS via-email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of UHS. No fee will be paid in the event the candidate is hired by UHS as a result of the referral or through other means.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries.  We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: or 1-800-852-3449.

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