The primary purpose of the PBS Specialist position is to follow-up on claims within regulatory guidelines. The PBS Specialist must ensure that all claims have a follow-up action according to timely filing limits and that all follow-up activities are performed accurately. Key Functions 1. Responsible for managing high-dollar claim work queues for follow-up and denials by engaging payor websites and initiating calls in order to ensure prompt payment 2. Maintains payor claims escalation workbooks i... more details
Mission Statement
The mission of The University of Texas M. D. Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.
Summary
The primary purpose of the PBS Specialist position is to follow-up on claims within regulatory guidelines. The PBS Specialist must ensure that all claims have a follow-up action according to timely filing limits and that all follow-up activities are performed accurately.
Key Functions
1.Responsible for managing high-dollar claim work queues for follow-up and denials by engaging payor websites and initiating calls in order to ensure prompt payment
2.Maintains payor claims escalation workbooks in an efficient and organized manner
3.Assists with training other team members
4.Responds to requests made by third party payors and in a timely manner
5.Responds timely to patient account inquires received from customer service
6.Identifies denial trends and notifies Supervisor and/or Manager to prevent future denials and further delay in payments. Makes recommendations for resolution
7.Pursues appeals when available. Initiates communication with coding team and clinical staff when coding related and medical necessity appeals are warranted
8.Consistently reviews processes and recommends any areas of opportunities with assigned payors
9.Written communication demonstrates clear action taken on each account as well as what further action is needed to capture payment. Work output is documented clearly, so that various departments involved in resolution can review the account
10.Achieves improved team performance by completing assigned special projects
11.Identifies, analyzes and escalates trends affecting AR collections
12.Provides verbal and written communication while assisting management in addressing issues with difficult claims and aging
13.Facilitates department training by assisting other team members in payor source education and knowledge sharing as requested by Management
14.Ability to meet departmental standard for quality and productivity
Other duties as assigned
Working Conditions
This position requires:
Working in Office Environment
______ No
__X__ Yes
Working in Patient Care Unit (e.g. Nursing unit; outpatient clinic)
__X___ No
______ Yes
Exposure to human/animal blood, body fluids, or tissues
__X___ No
______ Yes
Exposure to harmful chemicals
__X___ No
______ Yes
Exposure to radiation
__X___ No
______ Yes
Exposure to animals
__X____ No
______ Yes
Physical Demands
Indicate the time required to do each of the following physical demands:
Time Spent
Never
0%
Occasionally
1-33%
Frequently
34-66%
Continuously
67-100%
Standing
X
Walking
X
Sitting
X
Reaching
X
Lifting/Carrying
Up to 10 lbs
X
10lbs to 50 lbs
X
More than 50 lbs
X
Pushing/Pulling
Up to 10 lbs
X
10lbs to 50 lbs
X
More than 50 lbs
X
Use computer/keyboard
X
Required:
Associate's degree in Business Administration or related field.
Required:
Four years of experience in a business office setting to include two years experience in billing, governmental regulations and/or claims adjustment. May substitute required education degree with additional years of equivalent experience on a one to one basis.
Preferred:
Experience in billing and collections for Medicare and Managed Medicare payors. Denials and claims experience in a hospital setting.
Other Requirements:
Must pass pre-employment skills test as required and administered by Human Resources.
It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html
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