Sr. Patient Account Specialist - RCO HB Follow Up

Sr. Patient Account Specialist - RCO HB Follow Up

• Galveston, Texas, United States
• Business, Managerial & Finance UTMB Health Requisition # 2603085

• EDUCATION & EXPERIENCE

• Minimum Qualifications:

• + Associate's degree or equivalent. + Minimum of three years patient accounts experience. + Minimum of two years Epic Revenue Cycle experience.

• Preferred Qualifications:

• +

Role-Specific Experience:

Two to three years of hands-on experience in medical billing, revenue cycle, or claims denial management in a hospital (HB) or large clinical setting. +

Insurance Knowledge:

Working knowledge of commercial insurance, Medicare, Medicaid, and Texas-specific managed care guidelines. +

Denial Processes:

Demonstrated ability to identify, appeal, and resolve complex claim denials (e.g., underpayments, medical necessity rejections, and bundling issues). +

Coding:

Proficiency in navigating medical coding sets, including ICD-10, CPT, and HCPCS. +

Analytical Skills:

Experience investigating denial root causes (e.g., coding errors, medical necessity, timely filing limits) and drafting formal appeals.

• JOB SUMMARY

• The Sr.

Patient Account Specialist will be responsible for billing all third-party payers through a claims processing vendor and/or for appeal of denied professional and/or hospital claims. Identifies billing issues affecting hospital and/or physicians claims/accounts and takes necessary action to ensure timely and appropriate claim filing. Performs follow-up activities and identifies reimbursement issues affecting these claims. Takes necessary actions to ensure timely and appropriate reimbursement and account resolution.

• ESSENTIAL JOB FUNCTIONS

• + Demonstrates an expert level of competence and understanding of all state and federal laws, rules, and regulations regarding payer billing guidelines + Demonstrates a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as POS requirements + Meets or exceeds QA and Productivity requirements + Billing payers and/or clients for hospital and/or Professional Patient Accounts + Resolves Payer rejections from billing system daily to bill submit hospital and/or physicians claims + Performs online corrections to edited claims according to procedures + Performs detailed follow-up activities on assigned accounts according to procedures + Responds to daily correspondence according to procedures + Identifies denials and underpayments for appeal + Reviews, researches, and processes denied claims + Appeal claims as appropriate according to policies and procedures + Updates account information and documents as appropriate within Epic Resolute + Processes account adjustments according to policies/procedures + Issues payer and/or patient refunds according to policies/procedures + Validates accuracy of payments and/or adjustments on accounts + Resolves outstanding accounts at required accuracy and productivity requirements + Assists in the training and mentoring of new employees + Performs quality assurance reviews + Assist in the coordination of reporting and feedback to stakeholders + Maintains comprehensive knowledge of the work unit assigned + Assists in the development of department policies and procedures + Adheres to established policies and procedures + Adheres to internal controls and reporting structure + Maintains open and professional communication with customers, colleagues, and vendors + Performs well in a team environment •

Marginal or Periodic Functions:

• + Successfully completes competency-based training and testing + Prioritizes and completes all work in an accurate, effective, and efficient manner + Participates in team meetings/activities and supports the philosophy and goals of the team and department + Assists in the training and mentoring of new employees + Reads all announcements and relevant communications relating to job duties + Performs related duties as required.

• WORKING ENVIRONMENT/EQUIPMENT

• + Standard hospital, clinical, laboratory and/or office environments. + Standard office equipment.

• SALARY RANGE

• Actual salary commensurate with experience.

• WORK SCHEDULE

• On-site, Monday through Friday, 8 AM - 5 PM.
• Equal Employment Opportunity
• UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law.

As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities. Compensation