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

UTMB Health•Galveston, TX

2d•Hybrid

About The Position

The Senior Patient Account Specialist is responsible for billing third-party payers through a claims processing vendor and/or appealing denied professional and hospital claims. The role identifies billing issues affecting hospital or physician accounts and takes action to support timely, accurate claim submission and reimbursement. It performs account follow-up, investigates reimbursement issues, and works toward account resolution. The specialist works in Epic Resolute to update account information and documentation, process adjustments and refunds, validate payments, and research and appeal denials or underpayments. The role also supports quality assurance, reporting and feedback to stakeholders, policy and procedure development, and the training and mentoring of new employees. Representatives work a hybrid schedule with at least one in-office day per month; other scheduled workdays are remote. Remote shifts are eight hours, Monday through Friday, with scheduled hours between 6:00 a.m. and 6:00 p.m., subject to departmental guidelines and operational needs.

Requirements

Associate’s degree or equivalent.
At least three years of patient accounts experience.
At least two years of Epic Revenue Cycle experience.
Expert-level 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 or exceed quality assurance and productivity requirements.
Ability to complete an eight-hour shift Monday through Friday, with scheduled hours between 6:00 a.m. and 6:00 p.m. when working remotely.

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 check claim status, provider manuals, and reimbursement methodologies.
Proficiency navigating medical coding sets, including ICD-10, CPT, and HCPCS.
Ability to investigate denial root causes, such as coding errors, medical necessity, or timely filing limits, and draft formal appeals.

Responsibilities

Bill third-party payers and/or clients for hospital or professional patient accounts.
Resolve payer rejections from the billing system daily and submit hospital or physician claims.
Make online corrections to edited claims according to procedures.
Conduct detailed follow-up activities 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 required accuracy and productivity standards.
Assist with training and mentoring new employees and perform quality assurance reviews.
Assist in coordinating reporting and feedback to stakeholders.
Maintain comprehensive knowledge of the assigned work unit and assist in developing department policies and procedures.
Adhere to 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, read communications related to job duties, and perform other related duties as required.