Reimbursement Officer II

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Brief Job Description:

Come work in an environment where we truly value and respect those we serve and believe in the mission that all people can achieve a higher level of wellness and independence. 

The state supported living centers serve people with intellectual and developmental disabilities who are medically fragile or who have behavioral problems. The centers provide campus-based direct services and supports at 13 centers located throughout the state. Learn About Our State Supported Living Centers

If you are looking for a place to work where you can establish a career that is filled with purpose, this is the job for you!

The Reimbursement Officer performs moderately complex reimbursement and claims processing work at

the Austin State Supported Living Center on behalf of the individuals and the Slate of Texas. Work

involves determining eligibility, obtaining financial information, maintaining accounts, and collecting

charges for the support, maintenance, programs, and services provided to individuals. Obtains financial

information for individuals residing at the SSLC, establishes and maintains accounts receivable in an

automated data system and processes claims against 3 party sources. Contacts appropriate agencies

for Medicaid, Medicare, insurance, and other payee sources. Performs various activities necessary for

collection of Medicaid and Medicare including completing applications, submitting forms, calculating

billing rates and maintain accounts. Monitors and reports changes in individuals’ incomes, resources,

and levels of care. Reviews system reports and takes necessary action to ensure accuracy and correct

errors. Research claim denials and discrepancies and takes appropriate action. Maintains

confidentiality and discretion in activities. Maintains a professional and helpful demeanor and attitude

when working with individuals, staff members, legally authorized representatives (LARs), 3 party payors

and other stakeholders. Ensures all activities conform to established procedures as stated in applicable

policies and manuals. Performs other duties as assigned to ensure the overall effective of the

reimbursement department. Works under the general supervision of the Reimbursement Officer IV or

other appropriate staff depending on facility structure, with moderate latitude for the use of initiative and

independent judgment.

Essential Job Functions (EJFs):

Attends work on a regular basis and may be required to work a specific shift schedule or, at times, even a

rotating schedule, extended shift and or overtime in accordance with agency leave policy and performs

other duties as assigned.

Analyzes financial information for ability-to-pay determinations. Interviews individuals, relatives, or

guardians of clients to determine the proper rates to be charged for support, maintenance, and program

and services provided to clients.

Completes application process for benefits from available programs such as Social Security, Supplemental Security Income (SSI), VA, Civil Service and Railroad programs on behalf of individuals with potential eligibility.

Performs various activities necessary to collect Medicaid under the ICF/lD program completes and

submits applications and Forms 9Ol; calculates billing rates; maintains accounts in automated mainframe

data system; monitors and reports changes in individuals’ income, resources, and level of care to Texas

Health and Human Services and Social Security; and calculates monthly work earning budgets.

Performs various activities necessary to maintain Medicaid eligibility; completes all required Medicaid eligibility

forms; Form 1200-PFS, PFS-2, SSA-454, and SSA-455.

Monitors various activities necessary to collect Medicare Part B reimbursement for physicians’ services

including consolations and surgery and ancillary services including lab, radiology, EEG, EKG, vaccines,

injections, and venipunctures.

All activities conform to established procedures as stated in the ID Reimbursement Policy and Procedure Manual. Reviews and analyzes documents to identify and determine the appropriate claim source.

Performs all tasks associated with the Medicare Part D prescription drug program including but not limited to new applications.

Verification of coverage, data entry and revenue reconciliations.

Performs various activities necessary to enter non-third-party financial transactions not the automated data system in accordance with established policy and procedures.

Prepares correspondence, forms, and reports and maintains records of assigned cases.

Assists in processing protests and appeals. Refers claims or accounts requiring legal assistance to appropriate staff.

Establishes and maintains accounts receivable and enters transactions into the automated system.

Reviews VPS system reports and takes necessary action.

Performs other duties as assigned to ensure the optimal functioning of the reimbursement department including office functions such as maintenance of files, distribution of daily mail, answering telephone, greeting visitors, cross training, work processing and photocopying documents.

Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location.

Knowledge, Skills and Abilities (KSAs):

• Knowledge of verifying insurance benefits and eligibilities; processing and submitting Medicaid, Medicare and/or Private insurance claims.
• Knowledge of working with an electronic patient record and automated billing system.
• Knowledge of, or ability to gain knowledge of, rules and regulations governing reimbursement for state agency services.
• Knowledge of, or ability to gain knowledge of, trust fund rules and procedures related to collection of reimbursement for services.
• Skill in organizing and prioritizing tasks, problem solving and decision-making.
• Skill in maintaining an accurate confidential filing system.
• Skill in compiling and preparing accurate billing reports.
• Skill in Utilizing Microsoft Office including, but not limited to Word, Excel, and Power Point.
• Skill in collecting and posting payments to patient’s accounts.
• Ability to follow written and oral instructions.
• Ability to have strong, positive, and effective communicating skills both verbally and in writing.
• Ability to establish and maintain strong positive effective working relationships with co-workers, the general public, other state agencies, service providers, and supervisors,
• Ability to work well under pressure with limited time constraints.
• Ability to perform mathematical computations.

Registrations, Licensure Requirements or Certifications:

None

Initial Screening Criteria:

• High School diploma or equivalent.
• Experience in claims processing and/or health-related account and collection work.
• Experience with preparing and billing medical claims with private, managed care and/or government insurance agencies is preferred.
• Experience working in a collection environment, working with an automated billing system is preferred.

Additional Information:

Applicants must pass a fingerprint criminal background check, pre-employment drug screen, and registry checks including the Client Abuse/Neglect Reporting System (CANRS), Nurse Aide, Medication Aide and Employee Misconduct and HHS List of Excluded Individuals/Entities (LEIE).

Males between the ages of 18 – 25 must be registered with the Selective Service.

All State Supported Living Center Employees are subject to Random Drug Testing.

Flexibility in work hours may be required for this position. The position may be required to work overtime and/or extended hours. Must be willing to work weekends and holidays.

All applicants must be at least 18 years of age to be considered for employment at a state-operated facility.

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form