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

UTMB Health•Galveston, TX

10d•Hybrid

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 or physician claims and accounts, takes action to ensure timely and appropriate claim filing, conducts follow-up, and identifies reimbursement issues. The specialist takes necessary actions to support timely reimbursement and account resolution. This position requires knowledge and application of applicable state and federal payer billing rules and procedures, as well as basic familiarity with CPT, ICD-9, HCPCS, modifier coding, and place-of-service requirements. The specialist works with patient accounts, resolves payer rejections and edited claims, researches and appeals denials, processes adjustments and refunds, and maintains account documentation in Epic Resolute. The role also supports department procedures, communicates professionally with customers, colleagues, and vendors, and contributes to team activities and training. The work environment is a standard hospital, clinical, laboratory, and/or office environment using standard office equipment. This is a hybrid remote position with standard business hours, Monday through Friday, and no weekends or rotating shifts. Salary is commensurate with experience.

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 account 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/EHR system.

Responsibilities

Bill third-party payers and/or clients for hospital and 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.
Perform detailed follow-up on assigned accounts and respond to daily correspondence according to procedures.
Identify denials and underpayments; review, research, process, and appeal denied 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 requirements.
Maintain comprehensive knowledge of the assigned work unit.
Assist in developing department policies and procedures and adhere to established procedures and internal controls.
Maintain open, 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 related to job duties and perform related duties as required.