Revenue Representative – Appeals and Collection

Key Responsibilities

• Manages outstanding Accounts Receivable for 3rd party payer as necessary to ensure account balances are reviewed to determine collectability.
• Analyze Explanation of Benefits (EOBs), remittance advices, claims history, medical records, and HCFA 1500 forms to determine claim accuracy and appropriate appeal strategy.
• Research payer policies, member coverage, and regulatory guidelines to support reconsiderations, disputes, and formal appeals.
• Prepare and submit timely first-level and subsequent appeals to ensure compliance with filing deadlines.
• Manage and monitor outstanding insurance accounts receivable, including follow-up with commercial and government payers to secure payment or appropriate balance adjustment.
• Conduct collection activities to resolve unpaid claims and reduce aged receivables.
• Review the status of previously appealed or pended claims to ensure resolution within established timeframes.
• Maintain accurate and detailed tracking notes in the EMR/billing systems.
• Identify denial or collection trends, recurring issues, or areas of concern and communicate findings to leadership in a timely manner.

Qualifications

• High School Diploma or General Education diploma
• One (1) year of reimbursement experience, along with working knowledge of government and commercial insurance payer guidelines and appeal process.
• Computer literate, detailed oriented and have a working knowledge of excel, ICD-10, and CPT coding.

Knowledge, Skills & Abilities

• Well-developed interpersonal, organizational and problem-solving skills and be a team player with a desire to provide a high level of customer service;
• Possess strong verbal and written communication skills and interact effectively at all levels within the organization.

About Us

The Harris Center is the state-designated Local Mental Health Authority and Local Intellectual and Developmental Disability (IDD) Authority serving Harris County, Texas. As the largest behavioral and developmental disability care center in Texas, The Harris Center provides care to over 90,000 people and has an annual budget of over $300 million. As part of its mission to transform the lives of people with behavioral health and IDD needs in the third largest county in the United States, The Harris Center provides a full continuum of services at 80 different sites across Harris County. In addition, services are provided in more than 40 different languages as well as sign language in order to better serve what is one of the largest communities in the nation. By utilizing the unique expertise of its more than 2,500 employees, The Harris Center is committed to meeting the behavioral health and IDD needs of Harris County residents and giving them hope to live to their fullest potential.

What Else You Should Know

• This posting is associated with position number 1225