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

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

3d•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 specialist identifies billing issues affecting hospital or physician claims and accounts, takes action to support timely and appropriate claim filing, performs account follow-up, and identifies reimbursement issues. The role takes necessary actions to ensure timely reimbursement and account resolution. The position handles payer billing and claim follow-up, including resolving rejections, correcting edited claims, researching and appealing denials, processing account adjustments and refunds, and validating payment accuracy. It also supports quality assurance, reporting and stakeholder feedback, policy and procedure development, and training and mentoring. The work is performed on a hybrid schedule, with at least one in-office day per month and the remaining scheduled workdays remotely. Remote shifts are eight hours Monday through Friday, scheduled between 6:00 a.m. and 6:00 p.m., subject to departmental guidelines and business 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 perform the duties accurately and meet required quality assurance and productivity standards.

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.
Analytical 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 and professional patient accounts.
Resolve payer rejections from the billing system daily to submit hospital and physician claims.
Make online corrections to edited claims according to procedures.
Perform detailed follow-up activities on assigned accounts and respond to daily correspondence.
Identify denials and underpayments for appeal; review, research, process, and appeal denied claims as appropriate.
Update and document account information in Epic Resolute.
Process account adjustments and payer or patient refunds according to policies and procedures.
Validate the accuracy of payments and account adjustments.
Resolve outstanding accounts while meeting accuracy and productivity requirements.
Meet or exceed quality assurance and productivity requirements and perform quality assurance reviews.
Assist with training and mentoring new employees.
Assist in coordinating reporting and feedback to stakeholders.
Maintain comprehensive knowledge of the assigned work unit and assist with developing department policies and procedures.
Adhere to established policies, procedures, internal controls, and reporting structure.
Maintain open and professional communication 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 relevant announcements and communications, and perform related duties as required.