Patient Account Representative

UMC Health System; United States; On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

Resilience program

Health insurance

Retirement benefits w/Employer Match

PTO & Extended Illness

Medical, Dental, & Vision Insurance

On-Site Professional Counselors (EAP)

Discounted Pharmacy

Job summary

UMC Health System is seeking a detail-oriented Billing Specialist to manage in-network and out-of-network accounts in accordance with payer rules and MTALA guidelines. You will handle reimbursements, coding, and documentation with strong attention to accuracy.

The ideal candidate has solid communication skills, basic accounting knowledge, and the ability to adapt to changing rules in a fast-paced health system environment.

Qualifications

• High school graduate or equivalent required.
• Some college preferred.
• Experience in medical billing a plus.

Responsibilities

• Manage in-network and out-of-network accounts per payer rules.
• 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.
• 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 recurring 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.
• 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 strives 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/written comms

Mainframe skills

Basic accounting

Clerical accuracy

Problem-solving

Adaptability

Education

High school diploma

Some college preferred

Tools

Medical billing software

Job description

JOB SUMMARY

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.

REPORTS TO

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 strives 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.

BENEFITS

• Resilience program
• Emotional
• Physical
• Spiritual
• Financial
• Career
• Community
• On-Site Professional Counselors (EAP)
• Discounted Pharmacy
• Cost Cash Retention Bonus (only one in our region)
• Retirement Benefits w/Employer Match
• PTO & Extended Illness
• Medical, Dental, & Vision Insurance
• And more at: https://apps.umchealthsystem.com/documents/wellness.pdf

UMC Vision, Mission and Standards

Vision: To Serve Our Patients in the Best Teaching Hospital in the Country

Mission Statement: Service is our passion. We serve by providing safe, high quality care to all, achieving excellent financial performance, and training tomorrow’s healthcare professionals.

Standards of Excellence: Attitude, Communication, Responsiveness, Compassion, Teamwork, Ownership, Safety and Respect

UMC Physicians Culture, Vision, Mission, and Standards

Culture: Service is Our Passion

Vision: The best place to work and the best place to receive healthcare.

Mission Statement: To improve the quality of life for our community by providing the best patient experience for every patient.

Standards: Teamwork, Respect, Accountability, Compassion, Kindness

About UMC

Magnet Designated 501 licensed beds 62 Site locations Regions only Level I Trauma Center Regions only BICU DNV accredited Primary teaching hospital for the Texas Tech University Health Sciences Center (TTUHSC) Ranked as one of the Best Places to Work in Texas by Texas Monthly UMC Physicians Culture, Vision, Mission, and Standards: Culture: Service is Our Passion Vision: The best place to work and the best place to receive healthcare. Mission Statement: To improve the quality of life for our community by providing the best patient experience for every patient. Standards: Teamwork, Respect, Accountability, Compassion, Kindness

About UMCP

35 Practice Locations – private practices and urgent care centers Over 125 physicians and advanced practice providers Ranked as One of the Best Places to Work in Texas by Texas Monthly Employee Engagement Score of 96% measured by Press Ganey Associates