With 100+ physicians in 20 specialties, Collom & Carney Clinic serves the healthcare needs of more than 200,000 active patients. This "Physician Owned" group has been a staple in East Texas for the past 70 years. Medical Group Management Association (MGMA) has recognized Collom & Carney as a better performer in the "Performance and Practices of Successful Medical Groups." The clinic has received this distinction since 1998, the first year criteria was developed for this award. The clinic has always maintained a standard of professionalism and excellence, yet within a friendly working environment. All of our physicians are provided with the best resources available, including state-of-the-art equipment, superior staff support, and administrative assistance.
Taking care of all accounts with Blue Cross Blue Shield as their primary insurance.
1. File all Texas and Arkansas Blue Cross Plans Claims. This involves making sure all correct information is printed on the claims before mailing them.
2. Works all above insurance denials. Must decide why a claim was denied, correct it if possible and re-file as soon as possible.
3. If a procedure is denied that we cannot collect on, maybe the procedure is bundled or global, then you must write up a request for a write off to forward to Data Department.
4. Answer phone calls from the patients or other departments.
5. File all supplement insurance claims, which involves matching the claims with the Blue Cross EOB’s and mailing them.
6. Order claims form EOB’s that don’t have a matched claim and vice versa.
1. High school graduate or equivalent.
2. Computer experience.
3. Must know how to use a CPT book and ICD-10 book. At least 2 - 4 weeks of training is required.
4. At least one year follow-up experience on claims is desirable.
QUALIFICATIONS
1. Pleasant, friendly disposition with the ability to work with patients as well as employees.
2. Awareness of need for discretion and for keeping confidential all matters relating to clinic, the employees and the patients.
3. Intelligence to use judgement and initiative in determining the course of action with filing claims.
4. Ability to handle stressful situations while remaining calm.
5. Exhibits a cooperative helpful manner toward co-workers.
6. Tact and diplomacy when dealing with patients.
Perform audits as requested for the compliance process improvement, coding validation and other processes that affect reimbursement. Responsibilities also include recommending edits of CPT/ICD-10 codes and descriptions to conform to billing rules and compliance standards, and assist in insuring reimbursement integrity. Maintain a working knowledge of Medicare/Medicaid/Third Party Payers payments regulations and mechanisms for payment while serving as a resource for facility staff for compliance/coding questions.
Must have an understanding of federally funded payer reimbursement regulations. Ability to work independently on multiple, complicated tasks with little or no intervention. Excellent oral and written communication skills. Must have ICD and CPT code knowledge, computer literacy and chart/bill audit experience preferred. Demonstrate ability to maintain strict confidentiality.
Must be a graduate of accredited School of Nursing or credentialed healthcare professional.
The Pediatric Population Health Coach (PHC) is an integral part of the Patient Center Medical Home (PCMH). Responsible for outreach to patients through various avenues, with the goal of improving population health, reducing healthcare cost and enhancing patient experience. Focusing on the quality metrics to ensure gap closure for the PCMH population. Gap closure helps identify an opportunity to improve the overall health of the patient. The PCH will play a vital role in the clinical, financials & education of patients & will ensure these aspects are all considered simultaneously throughout the continuum of care.
1. Collaborates with clinical staff to coordinate & gather pertinent information from patients to support clinical management of chronic conditions & close quality gaps
2. Promotes health education & provides literature to patients to enhance understanding of a condition, ER utilization or social determinants of health
3. Actively manages a patient panel ensuring care plan completion
4. Increases individual patient engagement, capability, and accountability through regular patient contact
5. Communicating with & obtaining the approval of the patient and/or the parent to arrange appropriate care
6. Assist patients in addressing questions to their physician
7. Demonstrates sensitivity to issues & shows pro-active behavior in addressing client & patient needs
8. Manually &/or electronically documents interventions in designated template/system
9. Demonstrates continued dedication to the field of health coaching through continuing education & pursuit of new certification
10. Usage of Excel
11. Utilize appropriate community health care resources to maximize patient’s healthcare outcomes
12. Maintain confidentiality & adheres to HIPAA requirements
13. Other duties as assigned
1. Current LVN/LPN license preferred or MA with 10 years of experience
2. Experience with pediatric Medicaid population a strong plus
3. Must processes a working knowledge of CPT/ICD codes
4. Two – three years experience of utilization or Case Management preferred
5. Knowledge of managed care principles regarding legal & regulatory requirements & confidentiality preferred
6. Must have excellent communications and presentation skills
7. Demonstrates diplomacy & professionalism when dealing with staff or patients
8. Knowledge of Patient Center Medical Home (PCMH) and Primary Care First (PCF)
