Patient Access Representative I / II / Senior - Katy Orthopedics

UTHealth Houston; Katy (TX); On-site; USD 42,000 - 65,000; Full time

Job summary

UTHealth Houston in Texas is seeking a Medical Billing and Eligibility Specialist to ensure medical necessity compliance, verify insurance eligibility, and post payments in the patient accounting system. This role supports accurate billing and smooth revenue cycle flow.

You will interact with patients and insurance companies, explain forms, and collect payments while adhering to university policies and security requirements.

Qualifications

• High School Diploma or equivalent required.
• 1 year of experience in a hospital or medical business office setting required.

Responsibilities

• Obtain demographic, insurance and financial information from patient or guarantor.
• Enter information accurately into the computer system.
• Explain all required forms to the patient or guarantor and obtain the necessary signatures.
• Ensure medical necessity compliance by obtaining necessary data, reviewing information, and obtaining signatures.
• Post payments in the computer system and generate the appropriate receipts.
• Communicate professionally with Physicians, Care Management, ancillary departments, nursing units, physicians' offices, insurance companies, patients and their families.

Job description

What we do here changes the world.

UTHealth Houston is Texas’ resource for healthcare education, innovation, scientific discovery, and excellence in patient care. That’s where you come in.

Individualized orthopedic care and customized treatment and training programs are delivered by experienced sports medicine-trained orthopedic surgeons, physical therapists, nutritionists, exercise physiologists, biomechanists, strength & conditioning coaches and athletic trainers. This experienced team, including orthopedic doctors, offers a comprehensive suite of services to help athletes perform at their highest level:

• Orthopedic injury prevention and evaluation
• Orthopedic surgery, including minimally invasive options
• Post-injury rehabilitation and physical therapy
• Sports concussion management
• Strength & conditioning training
• Performance testing
• Sports nutrition

In addition, advanced diagnostic imaging services and an ambulatory surgery center are conveniently located adjacent to the Institute to ensure a seamless treatment process.

Once you join us you won't want to leave.

It’s because we reward our team for the excellent service they provide.

Our total rewards package includes the benefits you’d expect from a top healthcare organization (benefits, insurance, etc.), plus:

• 100% paid medical premiums for our full-time employees
• Generous time off (holidays, preventative leave day, both vacation and sick time - all of which equates to around 37-38 days per year)
• The longer you stay, the more vacation you’ll accrue!
• Longevity Pay (Monthly payments after two years of service)
• Build your future with our awesome retirement/pension plan!

We take care of our employees!

As a world-renowned institution, our employees’ wellbeing is important to us. We offer work/life services such as...

• Free financial and legal counseling
• Free mental health counseling services
• Gym membership discounts and access to wellness programs
• Other employee discounts including entertainment, car rentals, cell phones, etc.
• Resources for child and elder care
• Plus many more!

Position Summary

Responsible for ensuring medical necessity compliance, verifying eligibility, and posting payments.

Position Key Accountabilities

• Obtains demographic, insurance and financial information from patient or guarantor.
• Enters information in computer system with a high degree of accuracy.
• May schedule patient appointments and enter required information in the computer system in an accurate and timely manner.
• Explains all required forms to the patient or guarantor and obtains the necessary signatures.
• Ensures medical necessity compliance by obtaining necessary data, reviewing Compliance System, communicating information to patient or guarantor and obtaining necessary signatures.
• Protects the financial integrity of the facility by collecting patient liability, establishing payment arrangements, discussing payment options and screening for eligibility.
• Completes complex financial counseling including the review and submission of charity applications.
• Identifies alternative resources for financial reimbursement.
• Verifies insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframes.
• Posts payments in the computer system and generates the appropriate patient receipts.
• Communicates in an effective and professional manner with Physicians, Care Management, ancillary departments, nursing units, physicians' office staff, insurance companies, as well as patients and their families (all Patient Access customers).
• Completes thorough and accurate documentation.
• Adheres to all university policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
• Performs other duties as assigned.

Certification/Skills

• None

Minimum Education

High School Diploma or equivalent required

Minimum Experience

1 year of experience in a hospital or medical business office setting required

Physical Requirements

Exerts up to 50 pounds of force occasionally and/or up to 20 pounds frequently and/or up to 10 pounds constantly to move objects.

Security Sensitive

This position is a security-sensitive position pursuant to Texas Education Code

• 51.215 and Texas Government Code
• 411.094. To the extent that a position requires the holder to research, work on, or have access to critical infrastructure as defined in Texas Business and Commerce Code
• 117.001(2), the ability to maintain the security or integrity of the infrastructure is a minimum qualification to be hired for and to continue to be employed in that position. Personnel in such positions, and similarly situated state contractors, will be routinely reviewed to determine whether things such as criminal history or continuous connections to the government or political apparatus of a foreign adversary might prevent the applicant, employee, or contractor from being able to maintain the security or integrity of the infrastructure. A foreign adversary is a nation listed in 15 C.F.R.
• 791.4. Residency Requirement:

Employees must permanently reside and work in the State of Texas.