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

UTMB Health•Galveston, TX

2d•Remote

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 specialist identifies billing issues affecting hospital or physician claims and accounts and takes action to ensure timely, appropriate claim filing. The role includes follow-up activities and identifying reimbursement issues, with actions taken to support timely reimbursement and account resolution. This position works primarily remotely, with occasional onsite attendance in Galveston, Texas, for training, meetings, and other departmental needs. The schedule is Monday through Friday, with eight-hour shifts flexibly scheduled between 7:00 AM and 5:00 PM. The work environment may include standard hospital, clinical, laboratory, and/or office settings, using standard office equipment. Salary is commensurate with experience.

Requirements

At least two years of financial experience or one year of patient accounts experience.
Demonstrated 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 perform assigned account follow-up and resolve outstanding accounts according to accuracy and productivity requirements.
Ability to communicate professionally and work in a team environment.

Nice To Haves

Experience with patient account follow-up, including contacting insurance payers to obtain claim status updates.
Experience researching and resolving insurance claim denials.
Experience using Epic Resolute.

Responsibilities

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