Patient Account Specialist - RCO HB Follow Up (Galveston)

Utmb; Galveston (TX); On-site; USD 42,000 - 62,000; Full time

Job summary

UTMB Health in Galveston seeks a Patient Account Specialist to manage billing for third-party payers and appeals of denied claims. You will follow up on accounts, resolve billing issues, and ensure timely reimbursements in accordance with procedures.

Responsibilities include updating patient and payer information in Epic Resolute, addressing denial trends, and collaborating with team members to meet productivity targets while maintaining compliance with state and federal regulations.

Qualifications

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

Responsibilities

• 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.

Skills

Financial experience

Patient accounts experience

Healthcare billing

Revenue cycle

Medical collections

Payer knowledge

Payer portals

Epic Resolute

Tools

Epic Resolute

Job description

Patient Account Specialist - RCO HB Follow Up (Galveston)

• 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.

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.

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