Patient Account Specialist - RCO HB Follow Up

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

3h•Onsite

About The Position

The Patient Account Specialist bills third-party payers through a claims processing vendor and/or appeals denied professional and hospital claims. The role identifies billing issues affecting hospital and physician claims or accounts and takes action to support timely, appropriate claim filing. It also follows up on accounts, identifies reimbursement issues, and works toward timely reimbursement and account resolution. The position requires knowledge of applicable state and federal payer-billing rules, familiarity with basic medical coding and place-of-service requirements, and the ability to research, correct, appeal, and resolve claims. The specialist documents and updates account information in Epic Resolute, processes adjustments and refunds, validates account payments, and meets accuracy and productivity requirements. The work is on-site Monday through Friday, 8 AM to 5 PM.

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 meet required accuracy and productivity standards.

Nice To Haves

One to three or more years of experience in healthcare billing, revenue cycle, or medical collections.
Strong understanding of Medicare, Medicaid, and major commercial insurance claim-filing guidelines.
Experience using insurance web portals to verify claim status, access provider manuals, and review reimbursement methodologies.

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 activities on assigned accounts.
Respond to daily correspondence according to procedures.
Identify denials and underpayments for appeal; 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 standards.
Maintain comprehensive knowledge of the assigned work unit and assist in developing department policies and procedures.
Adhere to established policies, procedures, internal controls, and reporting structures.
Communicate professionally with customers, colleagues, and vendors and work effectively as part of a team.
Complete competency-based training and testing; prioritize 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 relevant communications related to job duties.
Perform related duties as required.