Patient Account Specialist – RCO HB Follow Up

UTMB Health; Texas; On-site; USD 45,000 - 65,000; Full time

Job summary

UTMB Health in Texas seeks a Patient Account Specialist to bill third-party payers and manage denials, working with a claims processing vendor and Epic Resolute to ensure timely submissions and reimbursements. The role requires knowledge of CPT/ICD-9/HCPCS and payer guidelines, with on-site hours Monday–Friday in a hospital/clinic setting.

The ideal candidate has 2+ years of financial or 1+ year of patient accounts experience and familiarity with healthcare billing, coding basics, and payer

Qualifications

• Two years of financial experience or one year of patient accounts experience.
• Basic understanding of CPT, ICD-9, HCPCS and POS requirements.
• Experience billing payers and handling denials.

Responsibilities

• Bill third-party payers through a vendor or internal system.
• Perform follow-up on denied or underpaid claims and appeal as needed.
• Identify billing issues to ensure timely claim filing and reimbursement.
• Update account information and document actions in the patient accounting system.
• Maintain knowledge of payer guidelines and stay compliant with regulations.

Skills

Financial experience

Patient accounts

Tools

Epic Resolute

Job description

EDUCATION & EXPERIENCE:

Minimum Qualifications:

• Two years of financial experience or one year of patient accounts experience.

Preferred Qualifications:

• Role-Specific Experience:1-3 years of experience in healthcare billing, revenue cycle, or medical collections.
• Payer Knowledge: Strong understanding of Medicare, Medicaid, and major commercial insurance claim filing guidelines.
• Payer Portals: Experience utilizing insurance web portals to verify claim status, access provider manuals, and review reimbursement methodologies.

JOB SUMMARY:

The 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 a 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
• 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
• 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:

On-site, 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.