Health Care 


 Charge Master Analyst  - Payrate : $26.00 to $35.00 /hour


Work Schedule : 40 Hours a week
Location: Houston, Texas 77002

Job Description:

  • Maintains the corporate standard CDM to ensure CDM files are coded and structured for correct coding guidelines, billing guidelines and compliance with third party pay or rules, supporting LCMC hospitals and physician practices. Leverages CDM Management tools to evaluate CDM through various compliance checks. Maintains hospital pricing and fee schedules associated with CDM, working within system policies and procedures.
  • Assigns charge codes as requested by revenue producing clinical departments and practices, working within system wide policies and procedures and with direction from Revenue Integrity Liaisons.
  • Works with Revenue Integrity Liaisons and clinical departments and practices to create new CDM items and pricing for new services and items.
  • Participates in complete revenue cycle reviews, including Charge Description Master (CDM) and related audits with a focus on CDM management.
  • Develops, implements and maintains CDM Management policies, procedures and training materials.
  • Analyzes and verifies charging procedures, charge capture and charge reconciliation protocols. Analyzes billing error and denial data to identify root causes. Executes on work plans to correct identified deficiencies.
  • Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications. Executes on work plans to adapt systems and processes to accommodate changes.


REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
Must have advanced revenue code, CPT and HCPCS coding knowledge.

  • Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations
  • Solid understanding of multiple reimbursement systems including IPPS, OPPS, and Fee Schedule.
  • Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel, including administrative and management staff.
  • Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Windows, Outlook, Excel and Access.
  • Advanced knowledge of accurate sources for updating all applicable code sets (CPT/HCPCS, ICD-9, etc.).
  • Excellent organizational and project management skills.
  • Possess effective time management skills to permit handling of large workload.


EDUCATION/EXPERIENCE/LICENSURE:
Education: Bachelor’s Degree or equivalent work experience.
Experience: At least 5 years minimum recent experience in healthcare finance, revenue cycle management.
Certification/Licensure: Dual Hospital and Professional Coding Certification(s) preferred. (CPC, CPC-H, CCS, CCSP)


Please respond back with your updated resume and your full name if you wish to have your resume sent out for consideration to veronica@a1personnelinc.com. please be mindful you must have the experience to apply in order to apply. 

Patient Account Representatives  - Payrate $15/hr. -$18 /hr. 


Work Schedule : 40 Hours a week
Location: Houston, Texas 77081

Job Duties :

  • Utilizes payer website to get information on eligibility, EOBs, claim status and on-line inquires. This includes Well care, Bravo, Validity, Aetna, Cigna,Humana, Wellcare, Tricare, United Healthcare, Amerigroup, Molina Care Improvement and other payers.
  • Ensures that work queues are worked daily and monitor follow-up activities.
  • Update the system with any follow-up activities that are being worked or completed.
  • MUST HAVE EXPERIENCE WITH MEDICAID AND MEDICARE
  • Report payment variances, claim rejections payer reimbursement issues, or other system issues immediately to Management
  • Completes research daily on each account which includes reviewing EOBs. RAs and correspondence from payers that relate to account activities.
  • Monitor account reimbursement daily to ensure that payments are accurate and process timely. must be completed within 5 working days.
  • Update patient demographics, Insurance and other patient information
  • If discrepancy is identified with payment posted, ensures account is documented accordingly and initiates follow-up within 4-5 working days to resolve, collect additional monies owed or concludes discrepancy.
  • Applies appropriate adjustment on account which require additional contractual adjustments or a write-off.
  • Reviews patient account to determine the next collection action, whether negotiating payment arrangement or discount, proceeding with legal action or conducting additional insurance follow-up.


Please respond back with your updated resume and your full name if you wish to have your resume sent out for consideration to veronica@a1personnelinc.com. please be mindful you must have the experience to apply in order to apply. 

MEDICAL DATA ENTRY CLERK / BILINGUAL, ENGLISH/SPANISH

​​HARRIS COUNTY PUBLIC HEALTH 
Our client is looking for a Medical Data Entry Clerk - Bilingual on English/Spanish

  • Must have a clean background
  • Must complete our online application (www.a1personnelinc.com)
  • Must be Bilingual on Spanish/English
  • Job duties, Medical Data Entry, other duties as assigned.
  • PAY RATE: $17.00
  • ZIP CODE, 77026

CONTACT: aurora@a1personnelinc.com  -  713.773.2900 X209 UPDATED ON 10.17.2018

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 Licensed Pharmacy Technician- $16.00 to $18.00 an hour depending on experience


Work Schedule : 40 Hours a week
Location: Houston, Texas 77081

Skills : 2 -4 years of Healthcare Field experience and or Pharmacy Tech experience

  • Enrolling patients in drug manufacturer's Patient Assistance Programs and managing all records and paperwork associated with the process
  • Interacting with physicians, nurses, Formulary Management, social workers, pharmacists, Eligibility, drug sales representatives and pharmaceutical companies.
  • Assisting the Sr. Drug Replacement Analysts in preparing for IPAP audits
  • Educate physician, patient and drug sales reps on program mission, guidelines, requirements and appropriate referral for Patient Assistance Programs.
  • Problem-solve rejected applications.
  • Update patient assistance program reference, guidelines and materials
  • Tracking all drug reimbursement.
  • Preferred: Outpatient Pharmacy experience – if you don’t have this individuals that know how to articulate with physicians and healthcare providers would be a great asset as well.
  • Preferred: Pharmacy Insurance or PBM experience (i.e. previous jobs with Aetna, Humana etc.
  • Required: Must be a licensed pharmacy technician in the state of Texas with a good standing active license


Please respond back with your updated resume and your full name if you wish to have your resume sent out for consideration to veronica@a1personnelinc.com. please be mindful you must be a licensed pharmacy tech in order to apply. 

LVN Pre/Authorization Nurse Auditor -$22.00 -$26.00


Work Schedule  : 8am to 4:30 pm or 8:30 am to 5:00pm 

Location: 610 South and Westpark Drive ( 77081 )


  • Obtains authorizations for scheduled outpatient appointments, special procedures, tests, injections and higher level services.
  • Provides pertinent clinical information in a timely manner according to third party payer guidelines.
  • Evaluates the medical necessity for inpatient hospital admission and Outpatient appointments reviews the authorization of the services or  admission along with the estimated length of stay utilizing nationally recognized screening criteria.
  • Identifies issues that are impacting initial, continued stay, high level service and outpatient service authorizations.
  • Facilitates peer to peer review between the clinical staff and they payer for denied admissions/length of stay and outpatient services.
  • Participates in monthly departmental payer Provider Representative meetings.
  • Maintains all authorization information on the Auth/Cert screens in EPIC.  Information is to be specific enough to assist in the tracking and managing of denials.
  • Retrieves medical record information or any other clinical information needed for appealing the claim or denial of services
  • Participates in required Authorization education.
  • Interacts with all levels of clinical and administrative staff when addressing issues impacting inpatient denials.
  • Logs and maintains all denials on the Nurse Audit Log by recording the specific data associated by the data fields.   


 Job Qualifications

  • Handles all other special projects for Manager, or Director of Operations of Patient Financial Services as requested such as representing her in internal and external meetings.
  • Volunteers as a team members for special projects and ensure they complete these projects or assignments as needed.
  • Ensures that the employees of the department have current up-to-date policies and procedures that will assist them in meeting their goals.
  •  Ensures that the team members are responsible for assisting co-workers during heavy workloads and that they utilize their free time to complete tasks necessary to meet departmental/Harris Health System needs.
  • Ensures that existing and new work queues are worked appropriately.


Required Education:
Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program
1-3 years of hospital or medical clinic experience.
Required License, Certification, Association:  Active - Licensed Vocational Nurse (LVN) or LPN


Please email veronica@a1personnelinc.com if you are interested. 
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