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St. Joseph Health / Covenant Health AR Denials Rep - Full-Time in Lubbock, Texas

Covenant Health is seeking a Full time Day Shift AR Denials Rep for Lonestar CBO Department at Covenant Medical Group.

Job Summary:

Under the direction of the PFS manager (defined below by region), the Government Billing and Collections Representative I is responsible for claims billing and collections. This individual addresses claims edits, files all claims on both UB-04 and 837 file formats, and completes follow-up on outstanding accounts. In addition, this individual identifies functional issues and reports them to the PFS manager.

Essential Function:

  • Bill all primary government claims on ePremis (the electronic billing system) or prints to paper, if appropriate, with necessary edits to ensure compliant billing practices. Report any variances in workload to the PFS Manager.

  • Review claims for accuracy and completeness, collecting and verifying all documentation necessary for timely billing of patient accounts, including requesting and collecting medical records and other documents ensuring the acceptance of the claim.

  • Work all reports related to billing, such as work lists, hold reports, and rejection reports to ensure claims are submitted timely and accurately per department guidelines.

  • Identify recurring errors and corrections being made to claims and report these to the PFS Manager. Make recommendations to resolve problems.

  • Complete all secondary billing and rebilling. Ensures required attachments, such as remittance advices or explanation of benefit forms are appropriately attached, if required.

  • Resolve rejected claims and perform rebilling as needed.

  • Accurately document actions taken in the system of record to drive effective follow-up and ensure an accurate audit trail.

  • Maintain ongoing knowledge of Medicaid (Medi-Cal for Southern California), Medicare, and all other applicable party billing requirements and payor guidelines. Keep current with knowledge of facility payor contracting agreements. Understand billing timelines and urgency in meeting all claims and filing deadlines.

  • Complete account follow-up based on preset follow-up guidelines based on payor type and account balance; ensure that all activities related to hospital collection functions meet department requirements, maximize revenue collection, and achieve leading practice levels of performance:

• Verify claim is received by government payor timely in accordance with the timely filing limits of the contractual agreement and/or state regulations.

• Monitor accounts receivable daily through work lists and check claim status through payor claims department or online to ensure proper claims processing.

• Complete periodic payor phone calls to confirm claim status and drive claim resolution as dictated by department collections policies.

• Document follow-up activity or pertinent notes (e.g., date of receipt, reference number) within Meditech to track and record overall claim process history.

• Submit any necessary documentation to support claim processing if required by the contractual agreement, payor guidelines, or state laws.

• Report any critical account issues or barriers in the collections process to the Co-Op PFS Manager.

• Trend and document ongoing payor issues and notify PFS management.

  • Daily focus on attaining productivity standards, recommending new approaches for enhancing performance, and productivity when appropriate.

    Minimum Position Qualification:

    Experience: Experience in medical management computer applications.

    Preferred Position Qualification:

    Education: H.S. Diploma or GED


  • 1 year Health care business office experience or related field.

  • 3 years Medical billing and medical terminology.

Covenant Health is celebrating nearly 100 years of serving Lubbock and our South Plains region. As the oldest and largest health system in Lubbock and the region, we currently employ over 5,200 people with a medical staff of over 600 physicians.For nearly 100 years, Covenant has been driven by a mission of providing a Christian ministry of healing and caring for the whole person - mind, body and spirit. Our vision and differentiator is we are the only faith-based, integrated health network in the West Texas/eastern New Mexico region dedicated to a Christian ministry of healing.As an expression of our mission, we believe we hold an important Covenant with our patients and try and treat every interaction as Sacred Encounters.Our ministry includes six hospitals with over 1,100 licensed beds: Covenant Medical Center - CMC Covenant Children’s Covenant Specialty Covenant Plainview - PLV Covenant Levelland - LVL Trustpoint (joint venture: Rehab Hospital of Lubbock) Covenant Medical Group (CMG) Covenant Health Partners Hospice of LubbockCovenant Health's total service area includes 25 counties that covers most of West Texas and eastern New Mexico. The service area covers approximately 750,000 people and approximately 35,000 square miles.Covenant / St. Joseph Health (SJH) provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Covenant / St. Joseph Health (SJH) complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Positions specified as “on call, per diem” refers to employment consisting of shifts scheduled on as “as needed basis” to fill in for staff vacancies.

Company: Covenant Health

Category: Billing/ Insurance