Patient Account Specialist - RCO PB Follow Up (Hybrid Remote)

University of Texas Medical Branch (UTMB)•Galveston, TX

11d•Hybrid

About The Position

The Patient Account Specialist is responsible for billing third-party payers through a claims processing vendor and/or appealing denied professional and hospital claims. The role identifies billing issues affecting hospital or physician accounts and takes action to support timely, appropriate claim filing. It also conducts follow-up activities, identifies reimbursement issues, and works toward timely reimbursement and account resolution. The specialist works with payer billing requirements and coding concepts, resolves claim rejections and edits, researches and appeals denials, updates account information in Epic Resolute, and processes adjustments and refunds. The position requires accurate, productive account resolution, adherence to established policies and procedures, and professional communication with customers, colleagues, and vendors. The position is hybrid remote and follows standard business hours Monday through Friday, with no weekends or rotating shifts.

Requirements

At least two years of financial experience or one year of patient accounts experience.
Competence and understanding of state and federal laws, rules, and regulations regarding payer billing guidelines.
Basic understanding of CPT, ICD-9, HCPCS, modifier coding, and place-of-service requirements.
Ability to complete payer billing, claim follow-up, denial and underpayment review, appeals, account adjustments, and refund processing according to procedures.
Ability to meet required accuracy and productivity requirements.

Nice To Haves

Experience with end-to-end revenue cycle operations, such as billing, denials, and collections.
Knowledge of insurance verification, claims processing, and reimbursement guidelines.
Experience working with Commercial, Medicare, and Medicaid payers.
Experience with Epic or a comparable patient accounting or EHR system.

Responsibilities

Bill third-party payers and/or clients for hospital and professional patient accounts.
Resolve payer rejections from the billing system and submit hospital or physician claims.
Correct edited claims online according to procedures.
Perform detailed follow-up on assigned accounts and respond to daily correspondence.
Identify denials and underpayments, research and process denied claims, and appeal claims as appropriate.
Update account information and document activity in Epic Resolute.
Process account adjustments and issue payer or patient refunds according to policies and procedures.
Validate payment and adjustment accuracy on accounts.
Resolve outstanding accounts while meeting required accuracy and productivity standards.
Maintain knowledge of the assigned work unit and assist in developing department policies and procedures.
Follow established policies, procedures, internal controls, and reporting structure.
Communicate professionally with customers, colleagues, and vendors, and work effectively in a team environment.
Complete competency-based training and testing; prioritize and complete work accurately and efficiently.
Participate in team meetings and activities, support team and department goals, assist with training and mentoring new employees, and read relevant announcements and communications.
Perform related duties as required.