Senior Patient Account Specialist - RCO HB Follow-Up (Hybrid Remote)
Galveston, Texas, United States
New
Business, Managerial & Finance
UTMB Health
Requisition # 2604394
EDUCATION & EXPERIENCE:
Minimum Qualifications:
+ Associate’s degree or equivalent.
+ Minimum of three years patient accounts experience.
+ Minimum of two years Epic Revenue Cycle experience.
Preferred Qualifications:
+ 2+ years of Medical Billing and Revenue Cycle Operations (Understanding of Claims, EOBs/Remits, Cash Posting, Eligibility/Registration, Coding)
+ 2+ years working with various payers (utilizing payer websites - obtaining claim status, provider manuals, policies & reimbursement methodologies)
+ 2+ years utilizing work queues and documenting account notes
+ 2+ years of analytical skills & problem solving (ability to critically think & identifying root causes and trends)
JOB SUMMARY:
The Sr. 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 an expert 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
+ Meets or exceeds QA and Productivity 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
+ Assists in the training and mentoring of new employees
+ Performs quality assurance reviews
+ Assist in the coordination of reporting and feedback to stakeholders
+ 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 in Galveston (on-site expectations: as scheduled for departmental needs). Monday through Friday, 8-hour shifts with availability between 6 AM - 6 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