Patient Account Specialist - RCO HB Follow Up (Galveston)

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

3d•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, takes action to support timely and appropriate claim filing, follows up on assigned accounts, identifies reimbursement issues, and works toward timely reimbursement and account resolution. The position requires knowledge of state and federal payer-billing requirements and a basic understanding of CPT, ICD-9, HCPCS, modifiers, and place-of-service requirements. The specialist works with payer and patient accounts, resolves billing rejections, reviews and appeals denied claims, updates account records in Epic Resolute, processes adjustments and refunds, and validates payments and adjustments. The role also supports department procedures, communicates professionally with customers, colleagues, and vendors, and contributes to team activities and training. This is an on-site position in Galveston, scheduled Monday through Friday, 8 AM to 5 PM. The work environment may include standard hospital, clinical, laboratory, and/or office settings and uses 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 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 third-party payers and/or clients for hospital and professional patient accounts.
Resolve payer rejections from the billing system and submit hospital and 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; review, research, process, and appeal denied claims as appropriate.
Update account information and documentation in Epic Resolute.
Process account adjustments and issue payer or patient refunds according to policies and procedures.
Validate the accuracy of account payments and adjustments.
Resolve outstanding accounts while meeting accuracy and productivity requirements.
Maintain knowledge of the assigned work unit and assist in developing department policies and procedures.
Follow established policies, procedures, internal controls, and reporting structures.
Communicate professionally with customers, colleagues, and vendors and work effectively in a team.
Complete competency-based training and testing; prioritize and complete work accurately and efficiently.
Participate in team meetings and activities, support team and department goals, and assist with training and mentoring new employees.
Read announcements and relevant communications and perform related duties as required.