Job Description

About Avenue360 Health and Wellness

Avenue 360 is a FQHC that strives to provide high quality and caring service to promote healthy people and communities. Our 360-degree approach addresses medical needs and social and environmental challenges, like housing. Our compassionate care extends to those with and without insurance. We believe income must not determine the level of access to quality health care.

Providing comprehensive, high quality, and caring service is the core of what we do, whether medical, hospice care, engaging adult activities, and supportive housing programs. We strive to address the many social determinants of healthy living in Greater Houston.

Our Values PACT

• We take PRIDE in our work.
• We have a positive ATTITUDE.
• We are CURIOUS.
• We are COMMITTED.
• We are CARING and CUSTOMER-SERVICE oriented.
• We are a TEAM.
• We LEARN, GROW, and INNOVATE

Overview: The A/R Specialist is responsible for the company’s third-party medical claims processing and assisting patients and office staff with questions on insurance claims, authorizations, statements, and other billing issues. This position will submit and follow-up on medical claims for Managed Care Organization (MCO), Medicaid, Medicare, Other Federal, Private Insurance, and Workers Compensation.

Duties and Responsibilities:

• Work unpaid claims in follow-up work queues.
• Rebills/appeals claims within 30-45 days of denial date.
• Provide insurance companies with needed medical records or documents when requested.
• Identifies payer trends or issues and reports to leadership for resolution.
• Bill patients for non-covered services.
• Bill secondary and tertiary insurances after primary payment.
• Assist patients with self-pay balances.
• Always maintain proper work standards in productivity and quality.
• Other tasks as assigned by the Director, Revenue Cycle and Billing.

Education, Experience, Licensure/Certification and Skills/Abilities Related Requirements:

• High School Diploma required.
• 2 years billing experience
• 5 years collection experience
• FQHC collection experience preferred

Continuing Education and Training Requirements:

Participates in trainings required by the funding source and/or as required by licensure.