Patient Account Specialist – RCO PB Follow Up (Hybrid Remote)

UTMB Health; Texas; Hybrid; USD 40,000 - 70,000; Full time

Job summary

UTMB Health in Texas is seeking a Patient Account Specialist to manage third-party payer billing and appeals. You will work with a claims processing vendor and within Epic Resolute to resolve denials and ensure timely reimbursements.

The role requires knowledge of CPT/ICD coding basics, strong attention to detail, and the ability to navigate payer guidelines. Hybrid work environment with standard business hours.

Qualifications

• Two years of financial experience or one year of patient accounts experience.
• Knowledge of CPT/ICD coding basics and payer guidelines.
• Experience with end-to-end Revenue Cycle operations is preferred.

Responsibilities

• Bill payers for hospital and professional services.
• Resolve payer rejections and appeals.
• Perform follow-up on denied/underpaid claims.
• Update and document account information in Epic Resolute.
• Ensure timely and accurate reimbursement and account resolution.

Skills

Payer billing

Denials management

Epic Resolute

Accounts receivable

Tools

Epic Resolute

Job description

EDUCATION & EXPERIENCE:

Minimum Qualifications:

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

Preferred Qualifications:

• Experience with end-to-end Revenue Cycle operations (e.g., billing, denials, and collections).
• Knowledge of insurance verification, claims processing, and reimbursement guidelines.
• Experience working with Commercial, Medicare, and Medicaid payers.
• Experience with Epic or a comparable patient accounting/EHR system.

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 requirementsMaintains 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:

Hybrid remote position. Standard business hours, Monday through Friday, with no weekends or rotating shifts.

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.

Compensation