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

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

Galveston, Texas, United States

New

Business, Managerial & Finance

UTMB Health

Requisition # 2606135

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:

• 3-5 years of Epic Resolute Hospital Billing experience, including experience with HB work queues.

• Experience with institutional/facility billing, including UB-04 and 837I claims.

• Experience utilizing clearinghouse platforms, such as Availity, to research and resolve claim rejections.

• Experience researching and resolving claim edits, clearinghouse rejections, and payer-level rejections.

• Experience developing SOPs and/or training staff within a revenue cycle or billing environment.

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, 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