Reimbursement Technician
Texas Department of Family and Protective Services - Mexia, TX

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Administrative Assistant II/Reimbursement Technician performs advanced technical work in pursuit of reimbursement for services provided to individuals at Texas MR facilities. As delegated by the Reimbursement Manager, work involves obtaining financial information, establishing and maintaining accounts receivable in automated data systems, and processing claims against third-party sources. Works under the general supervision of and work is subject to review by the Reimbursement Manager.

Essential Job Functions:
A. Performs various activities necessary to collect Medicaid under the ICF/MR program: Applications and Forms 90 I are submitted promptly within 3 days of receipt of information; calculates billing rates; maintains accounts in automated system; monitors and reports changes in individuals' income, resources, and levels-of-care; reviews system reports and takes necessary action for any rejects or discrepancies; contacts local Medicaid representatives to resolve problems related Medicaid eligibility of individuals. Applications and Forms 90-Is are submitted promptly within 15 days of receipt of information. Necessary action on rejected claims is initiated no later than 30 days from the run date of the rejected claims report. Problems related to Medicaid eligibility are documented immediately and cases are worked.

B. Identifies, completes, or arranges application process for benefits from Social Security, Supplemental Security Income, Veterans Administration, or other agencies on behalf of indivduals with potential eligibility. Applications are prepared and submittted in accordance with the requirements of local offices. Actions and information are documented in the individual's file. All applications should be submitted to local agencies within 30 days of potential eligibility.

C. Performs various activities to collect Medicare Part B reimbursement for physicians' and ancillary services; distributes names of eligible individuals to Medicare coordinator; submits physicians' applications for enrollment; maintains price lists and coding information; compiles and submits electronic claims; posts payments, adjustments, or recoupments to accounts in automated mainframe system; maintains collection data; researches denials and discrepancies, and takes appropriate action for the resolution of the denial or discrepancy; and submits medical records as requested to the carrier. Claims are to be submitted no later than 30 working days after obtaining completed service sheets from Medicare coordinator. Follow-up on rejected claims and discrepancies is done within 30 days of discovery. Necessary collections reports are presented promptly upon requests.

D. Establishes and maintains accounts receivables and enters financial transactions into the automated data systems. Manual or electronic generated non-third party billings are submitted promptly to individual accounts held by the facility. Collections and receipts are posted within 5 days of receipts. Responses to inquiries are provided promptly and accurately to the degree possible.

E. Performs various activities necessary to continue to collect reimbursement from 3rd party and non-3rd party sources. Provides re-application forms and medical records required for continuing disability determinations to state and federal sources within 15 days of requests.

F. Performs regular office functions including file maintenance, answering telephones, greeting visitors, word processing, and photocopying documents on a daily basis

Knowledge Skills Abilities:
Knowledge of business English
Knowledge of spelling
Knowledge of arithmetic
Knowledge of office practices and procedures
Skill in operation of calculator
Skill in operation of computer terminal and PC equipment
Ability to maintain complex records and files
Ability to prepare technical and statistical reports
Ability to meet and deal effectively with the public
Ability to establish and maintain effective working relationships

Registration or Licensure Requirements:

Initial Selection Criteria:
Associate degree in a related field preferred. Experience in accounting or financial services may be substituted for the associate degree on a year by year basis.

Additional Information:
All applicants must pass: Pre-employment drug screen, DPS criminal background check and Client Abuse/Neglect Reporting system (CANRS), Employee Misconduct Registry and Nurse/Aide Registry checks. If selected, applicant will be subject to a FBI fingerprint check. Males between the ages of 18 - 25 must be registered with the Selective Service.

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

All applicants must pass: pre-employment drug screen, fingerprint, criminal background check, and Client Abuse/Neglect Reporting System (CANRS), Employee Misconduct Registry and Nurse/Aide Registry checks. Males between the ages of 18 – 25 must be registered with the Selective Service.

In compliance with the Americans with Disabilities Act (ADA), HHS 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.

Requisition 220414