Indigent Health Director in Marshall, Texas at Harrison County (TX)

Appointed by the Harrison County Commissioner’s Court, this position performs specific and accurate Medical Claims processing and reimbursements. This position works closely with the public, other County departments, local hospitals and medical providers. Responsible for performing a wide variety of clerical, technical and administrative work in support of the County Indigent Health Department. This position requires knowledge of the County Indigent Health Care Program (CIHCP) Handbook, specifically Section 4000, Service Delivery.

• Maintains up to date knowledge the County Indigent Health Care Program Handbook to accurately determine appropriate payment for eligible claims

• Coordinates with CIHCP Eligibility Specialist(s) on client eligibility for determining claims covered

• Responsible for learning and maintaining knowledge related to Clinical Procedure Codes (CPT), Diagnostic Related Group (DRG), and other applicable medical and billing codes

• Learns and maintains knowledge of billing software system
• Verifies accuracy of billing data and revises any errors

• Ensures bills are received within the 95-day timely filing period according to Chapter 61, ensures claims are settled in accordance with cost control standards

• Processes all claims, balances, prints, and provides EOBs and requisitions for payment to Auditors
• Monitors Medicaider to track other client payer sources
• Notifies Eligibility Caseworker of any changes to client benefits so CIHCP eligibility can be assessed
• Prepares documents to request reimbursements on appropriate billing

• Trains Eligibility Caseworker on jail medical claims process; ensures claims are processed timely and accordingly

• Notifies Eligibility Specialists if/when clients have exhausted their $30,000 limit
• Ensures all updates and policy changes set for by the State and TMHP are current to CIHCP billing
• Maintains accounting and billing records with appropriate notes, forms, and required information
• Serves as point of contact for hospitals and medical providers seeking client eligibility status

• Serves as liaison between client, medical provider, and pharmaceutical companies to communicate necessary information
• Reviews prescribed medications for CIHCP clients provided by medical providers and local contracted pharmacy to determine prescriptions that can be purchased at a lesser cost to the county or complete overrides when medically necessary
• Sets up and maintains CIHCP providers, requests W-9s, ensures all billing information is up to date, makes necessary changes in vendor and payment setup
• Receives and keeps record of hospital notifications of clients receiving services out of County

• Coordinates with MOU/BAAs associated with CIHCP providers

• Answers and returns calls in timely manner and clerical duties including but not limited to faxing, copying, scanning, typing, and data entry

• Regular attendance and timeliness are required

• High School Diploma or GED and 3 years’ experience processing and administering medical claims or related experience required
• Certified Coding Specialist (CCS) or related certification preferred
• Knowledge of the medical claims bill process including specific medical code processes
• Thorough understanding of the importance of confidentiality and non-disclosure according to the general standards set forth by HIPAA
• Ability to read, understand, and apply a variety of interrelated instructions, such as those found in complex guidelines, regulations and policies
• Knowledge of current federal and state legislation relating to entitlement benefits
• General knowledge of basic arithmetic, algebra and statistics including add, subtract, multiply, divide, interest, decimals and percentages
• General knowledge of community organizations, agencies and facilities related to entitlement programs
• Exceptional skill in establishing and maintaining effective working relationships with County staff, service organizations, and the general public
• General knowledge of basic hardware and software and uses of a variety of different computer operating systems such as Microsoft Office Work, Excel, Outlook
• Possess excellent communication skills in expressing oneself clearly and concisely, both orally and in writing

Other

• Must successfully complete background checks, post-offer drug screen, physical condition evaluation and/or other testing in accordance with Harrison County policy and/or as authorized by law.