Patient Account Representative

umchealthsystem; United States; On-site; USD 42,000 - 60,000; Full time

Job summary

UMC Health System in Texas is seeking a detail-oriented Billing Specialist to manage in-network and out-of-network accounts, ensure timely reimbursements, and adhere to payer rules. This role requires strong communication, accuracy, and knowledge of MTALA requirements.

You will handle contract knowledge, coding, and documentation, and coordinate with payers and internal teams to maintain cash flow while ensuring compliance with regulations.

Qualifications

• High school diploma or equivalent required.
• Some college preferred.
• Experience with third-party payer rules and MTALA knowledge helpful.

Responsibilities

• Manage and have knowledge of all contracts particular to your desk.
• Determine if correct reimbursement has been submitted by the payer and/or if credit is due to incorrect proration.
• Use the correct transaction codes when adjustments are required on a visit.
• All mail received should be worked within 48 hours from received stamped date.
• Inform Supervisor or Director of large dollar adjustments, at least weekly, utilizing the high dollar adjustment spreadsheet. Documentation is required either in NB or as a comment on the transaction adjustment.
• Work as a team member to ensure departmental cash collections goals are met or exceeded; this includes proper handling of credit balances.
• Work all hold bills assigned to you in a timely manner.
• Inform your Supervisor or Director of any reoccurring problems or issues immediately.
• Run your ATB twice a month to check for problem visits.
• Follow-up on visits that have no follow-up activity after the 28th date of the visit being billed.
• Document your work in Notes B consistently and in detail for all accounts worked.
• Letters requesting additional information from the patient or insured should be utilized only when you are unable to reach by phone or calls are unreturned. This is to ensure claims are billed and paid timely.
• All refunds should be worked promptly, and the Refund worklist should be kept at 50k or less.
• Assist with the Credit Balance report which prints weekly and is disbursed accordingly.
• Manage and comply with all rules and regulations specific to the accounts you are assigned.
• Attach all implant invoices and supportive documentation to the claim and submit promptly per contract with each payer.
• Retain and maintain all third-party payer remittance and status reports that you are in receipt of.
• Consistently identifies accurate FSC/Plan for visits, ensures patient\'s account is billed accurately by consistently utilizing "AW" function, and strides to be proactive by educating departments as needed on accuracy of FSC/Plan assignment.
• Always set an example of teamwork and a professional attitude.

Skills

Verbal and written communication

Computer skills

Basic accounting

Technical problem-solving

Adaptability

Education

High school diploma or equivalent

Some college

Job description

JOB SUMMARY

We've learned that what is best for patients is also best for employees. Learn more about why we are one of the Best Companies to Work for in Texas.

Ability to communicate both verbally and in writing, mainframe computer skills, basic accounting and detailed clerical skills and good customer relation skills. Manage the in network and out of network accounts according to third party payer rules, and to comply with MTALA rules and regulation. Have knowledge, and an understanding of medical and third party payer terminology.

JOB SPECIFIC RESPONSIBILITIES

• Manage and have knowledge of all contracts particular to your desk.
• Determine if correct reimbursement has been submitted by the payer and/or if credit is due to incorrect proration.
• Use the correct transaction codes when adjustments are required on a visit.
• All mail received should be worked within 48 hours from received stamped date.
• Inform Supervisor or Director of large dollar adjustments, at least weekly, utilizing the high dollar adjustment spreadsheet. Documentation is required either in NB or as a comment on the transaction adjustment.
• Work as a team member to ensure departmental cash collections goals are met or exceeded; this includes proper handling of credit balances.
• Work all hold bills assigned to you in a timely manner.
• Inform your Supervisor or Director of any reoccurring problems or issues immediately.
• Run your ATB twice a month to check for problem visits.
• Follow-up on visits that have no follow-up activity after the 28th date of the visit being billed.
• Document your work in Notes B consistently and in detail for all accounts worked.
• Letters requesting additional information from the patient or insured should be utilized only when you are unable to reach by phone or calls are unreturned. This is to ensure claims are billed and paid timely.
• All refunds should be worked promptly, and the Refund worklist should be kept at 50k or less.
• Assist with the Credit Balance report which prints weekly and is disbursed accordingly.
• Manage and comply with all rules and regulations specific to the accounts you are assigned.
• Attach all implant invoices and supportive documentation to the claim and submit promptly per contract with each payer.
• Retain and maintain all third-party payer remittance and status reports that you are in receipt of.
• Consistently identifies accurate FSC/Plan for visits, ensures patient's account is billed accurately by consistently utilizing "AW" function, and strides to be proactive by educating departments as needed on accuracy of FSC/Plan assignment.
• Always set an example of teamwork and a professional attitude.

EDUCATION AND EXPERIENCE

• High school graduate or equivalent required
• Some college preferred

REQUIRED LICENSURES/CERTIFICATIONS/REGISTRATIONS

None

SKILLS AND ABILITIES

• Ability to communicate both verbally and in writing
• Computer skills
• Basic accounting and detailed clerical skills
• Highly technical and problem-solving skills
• Ability to handle change within the workplace

INTERACTION WITH OTHER DEPARTMENTS AND OTHER RELATIONSHIPS

Internal: This position requires interaction with most other UMC departments, medical staff, technical personnel at TTUHSC and PNS.

External: This position also may interact with technical support analysts employed by contracted hardware and software vendors and Texas Workers Compensation Commission.

PHYSICAL CAPABILITIES

Work is of medium demand, walking, sitting, and standing most of the time while on-duty. Occasional lifting of equipment is required. Adequate hand/eye coordination and fine motor skills required for typing. Verbal communication and hearing are essential in dealing with co-workers and customers.

ENVIRONMENTAL/WORKING CONDITIONS

Works in a well-lighted, heated, and ventilated building.

DIRECT REPORTS

UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Request for accommodations in the hire process should be directed to UMC Human Resources.