Patient Account Specialist - RCO HB Follow Up

UTMB Health•Galveston, TX

2d•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 specialist identifies billing issues affecting hospital and physician claims or accounts and takes action to ensure timely, appropriate claim filing. The role performs follow-up activities, identifies reimbursement issues, and takes necessary steps to secure timely reimbursement and account resolution. The position requires knowledge of applicable state and federal payer billing laws, rules, and regulations, as well as a basic understanding of CPT, ICD-9, HCPCS, modifier coding, and place-of-service requirements. Work is performed on-site in a standard hospital, clinical, laboratory, and/or office environment using standard office equipment. The schedule is Monday through Friday, 8 AM to 5 PM. 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 meet required accuracy and productivity requirements.

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 payers and/or clients for hospital and professional patient accounts.
Resolve payer rejections from the billing system daily and submit hospital and/or physician claims.
Make online corrections to edited claims according to procedures.
Perform detailed follow-up activities on assigned accounts according to procedures.
Respond to daily correspondence according to procedures.
Identify denials and underpayments for appeal; research, process, and appeal claims as appropriate under policies and procedures.
Update and document account information 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.
Assist in developing department policies and procedures.
Adhere to established policies, procedures, internal controls, and reporting structure.
Maintain open and professional communication with customers, colleagues, and vendors, and work effectively as part of a team.
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 relevant communications relating to job duties.
Perform related duties as required.