Texas Health Action

General

• Execute Revenue Cycle production tasks, including but not limited to: claims submission, follow-up, payment, and denial management, ensuring accuracy, timeliness and compliance with payor requirements.
• Perform eligibility, coverage, and payer discrepancy resolution for claims and balances, including issues related to date of service coverage, coordination of benefits, demographic inconsistencies, benefit limitations, and diagnosis-related coverage determinations.
• Manage assigned work queues within athenaCollector, including claims on hold, resubmissions, follow-up, and aging review.
• Research and resolve insurance denials related to eligibility, coverage at date of service, and payer processing errors.
• Coordinate corrections with clinical or operational staff to obtain diagnosis clarification or updates.
• Monitor unpaid or underpaid claims, ensuring timely and compliant follow-up.
• Support accounts receivable management and contribute to denial category tracking and reporting.
• Support the review of high-balance laboratory accounts from Quest Diagnostics.
• Apply the same eligibility, coverage, and payer discrepancy resolution framework to laboratory balances, identifying root causes and appropriate resolution pathways.
• Coordinate with clinical staff when diagnosis clarification or coding updates are warranted.
• Collaborate with Quest billing representatives to resolve identified issues and facilitate claim reprocessing when applicable.
• Identify and flag recurring trends in laboratory billing issues to support workflow improvements.
• Identify balances eligible for internal financial assistance and coordinate transfer to the KPAP Program when appropriate.
• Collaborate with Patient Support Services and the KPAP Program Manager to initiate transfers of eligible patient balances to the KPAP internal assistance program.
• Ensure balances are appropriately routed when patients meet established financial eligibility criteria.
• Maintain accurate documentation and tracking of transferred balances within revenue cycle workflows.
• Support a patient-centered approach that balances fiscal responsibility with access to care.
• Assist the Director of Revenue Cycle in developing and refining revenue cycle workflows and Standard Operating Procedures (SOPs).
• Identify operational inefficiencies and recommend improvements.
• Support periodic coding audits and internal compliance reviews.
• Support the ongoing optimization of athenaCollector and related billing systems.
• Assist in preparation of A/R aging reports, denial trend summaries, and laboratory balance analytics.
• Collaborate with Clinical Operations, Health Information Management (HIM), Finance, and external partners to resolve revenue cycle issues.
• Support implementation of new payers, billing configurations, or system enhancements as directed.

Revenue Cycle Specialist