EDUCATION & EXPERIENCE:
Minimum Qualifications:
- Two years of financial experience or one year of patient accounts experience.
Preferred Qualifications:
- Expertise in Coding: Deep understanding of ICD-10, CPT, and HCPCS codes to correct mismatches and invalid codes.
- Claim Scrubbing Technology: Ability to use automated, real-time claim scrubbing tools to identify errors like missing patient data (DOB, sex) or invalid IDs before final submission.
- Software Proficiency: Familiarity with clearinghouse platforms (e.g., eMEDIX, Availity) and EHR/Practice Management systems to, for example, fix patient demographics at the root cause.
- Clearinghouse & Billing Software: Experience with platforms such as Availity, Change Healthcare, or TriZetto to monitor real-time claim statuses and perform batch edits.
- EDI (Electronic Data Interchange) Knowledge: Understanding X12 837 (claims) and 835 (remittances) file structures to identify "Loop" or "Segment" formatting errors.
- Regulatory Compliance: Mastery of HIPAA guidelines for handling Protected Health Information (PHI) and staying updated on payer-specific rules.
- Data Analysis: Ability to use Microsoft Excel to track rejection trends and identify systemic "root cause" issues in billing workflows.
JOB SUMMARY:
The Patient Account Specialist will be responsible for billing all third-party payers through a claims processing vendor and/or for appeal of denied professional and/or hospital claims. Identifies billing issues affecting hospital and/or physicians claims/accounts and takes necessary action to ensure timely and appropriate claim filing. Performs follow-up activities and identifies reimbursement issues affecting these claims. Takes necessary actions to ensure timely and appropriate reimbursement and account resolution.
ESSENTIAL JOB FUNCTIONS:
- Demonstrates a level of competence and understanding of all state and federal laws, rules, and regulations regarding payer billing guidelines
- Demonstrates a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as POS requirements
- Billing payers and/or clients for hospital and/or Professional Patient Accounts
- Resolves Payer rejections from billing system daily to bill submit hospital and/or physicians claims
- Performs online corrections to edited claims according to procedures
- Performs detailed follow-up activities on assigned accounts according to procedures
- Responds to daily correspondence according to procedures
- Identifies denials and underpayments for appeal
- Reviews, researches, and processes denied claims
- Appeal claims as appropriate according to policies and procedures
- Updates account information and documents as appropriate within Epic Resolute
- Processes account adjustments according to policies/procedures
- Issues payer and/or patient refunds according to policies/procedures
- Validates accuracy of payments and/or adjustments on accounts
- Resolves outstanding accounts at required accuracy and productivity requirements
- Maintains comprehensive knowledge of the work unit assigned
- Assists in the development of department policies and procedures
- Adheres to established policies and procedures
- Adheres to internal controls and reporting structure
- Maintains open and professional communication with customers, colleagues, and vendors
- Performs well in a team environment
Marginal or Periodic Functions:
- Successfully completes competency-based training and testing
- Prioritizes and completes all work in an accurate, effective, and efficient manner
- Participates in team meetings/activities and supports the philosophy and goals of the team and department
- Assists in the training and mentoring of new employees
- Reads all announcements and relevant communications relating to job duties
- Performs related duties as required.
WORKING ENVIRONMENT/EQUIPMENT:
- Standard hospital, clinical, laboratory and/or office environments.
- Standard office equipment.
SALARY RANGE:
Actual salary commensurate with experience.
WORK SCHEDULE:
Hybrid remote, Monday through Friday, 8 AM - 5 PM.
Equal Employment Opportunity
UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.
Compensation