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

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

1d•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 and physician claims or accounts and takes action to ensure timely, appropriate claim filing, reimbursement, and account resolution. Responsibilities include resolving payer rejections, correcting edited claims, following up on assigned accounts, researching and appealing denials, updating account information in Epic Resolute, processing adjustments and refunds, and validating payments. The specialist maintains knowledge of the assigned work unit, follows departmental policies and controls, and communicates professionally with customers, colleagues, and vendors. The position is hybrid remote in Galveston, with a Monday–Friday schedule from 8 AM to 5 PM.

Requirements

Two years of financial experience or one year of patient accounts experience.
Basic understanding of CPT, ICD-9, HCPCS, modifier coding, and place-of-service requirements.
Ability to understand and comply with applicable state and federal payer billing laws, rules, and regulations.

Nice To Haves

Expertise in ICD-10, CPT, and HCPCS coding to correct mismatches and invalid codes.
Ability to use automated, real-time claim-scrubbing tools to identify errors before claim submission.
Familiarity with clearinghouse platforms such as eMEDIX or Availity and with EHR or practice-management systems.
Experience with billing and clearinghouse platforms such as Availity, Change Healthcare, or TriZetto, including monitoring claim statuses and performing batch edits.
Knowledge of X12 837 claims and 835 remittance file structures to identify loop or segment formatting errors.
Knowledge of HIPAA requirements for handling Protected Health Information and payer-specific rules.
Ability to use Microsoft Excel to track rejection trends and identify root causes in billing workflows.

Responsibilities

Demonstrate competence and understanding of state and federal laws, rules, and regulations regarding payer billing guidelines.
Demonstrate a basic understanding of CPT, ICD-9, HCPCS, modifier coding, and place-of-service requirements.
Bill payers and/or clients for hospital and/or professional patient accounts.
Resolve payer rejections from the billing system daily to submit hospital and/or physician claims.
Perform 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.
Review, research, and process denied claims.
Appeal claims as appropriate according to policies and procedures.
Update account information and document as appropriate within Epic Resolute.
Process account adjustments according to policies and procedures.
Issue payer and/or patient refunds according to policies and procedures.
Validate the accuracy of payments and/or adjustments on accounts.
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.
Adhere to established policies and procedures, internal controls, and reporting structure.
Maintain open and professional communication with customers, colleagues, and vendors.
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 the philosophy and goals of the team and department.
Assist in training and mentoring new employees.
Read announcements and relevant communications relating to job duties.
Perform related duties as required.