Patient Account Specialist - RCO HB Follow Up (Galveston)

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 role identifies billing issues affecting hospital and physician claims or accounts and takes action to support timely, appropriate claim filing, reimbursement, and account resolution. It also performs follow-up activities and identifies reimbursement issues. The position requires knowledge of payer billing guidelines and a basic understanding of CPT, ICD-9, HCPCS, modifiers, and place-of-service requirements. The specialist works with hospital and professional patient accounts, resolves claim rejections and edits, researches and appeals denials, maintains account documentation in Epic Resolute, processes adjustments and refunds, and validates payments. The role follows established policies and procedures, meets accuracy and productivity requirements, communicates professionally, and contributes to team activities and training. The work is on-site at UTMB Health, Monday through Friday, 8 AM to 5 PM, in a standard hospital, clinical, laboratory, and/or office environment using standard office equipment. Salary is commensurate with experience.

Requirements

At least two years of financial experience or one year of patient accounts experience.
Demonstrate 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.
Professional communication skills and ability to work in a team environment.

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.
Identify billing issues and take action to ensure timely and appropriate claim filing.
Resolve payer rejections from the billing system and submit hospital and physician claims.
Make online corrections to edited claims according to procedures.
Perform detailed follow-up on assigned accounts and respond to daily correspondence.
Identify denials and underpayments; 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 required accuracy and productivity standards.
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 environment.
Complete competency-based training and testing; prioritize and complete work accurately, effectively, 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.