Patient Account Specialist - Revenue Cycle PB Billing & Denials

UTMB Health; Galveston (TX); Hybrid; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a detail-oriented Patient Account Specialist to manage billing and claims for third-party payers. This role is crucial in ensuring timely reimbursement and resolving billing issues, requiring a strong understanding of billing guidelines and coding standards. The ideal candidate will thrive in a collaborative environment, demonstrating competence in handling complex accounts and contributing to the development of department policies. If you're passionate about finance in the healthcare sector and eager to make a difference, this is the opportunity for you.

Qualifications

• High School Diploma or equivalent required.
• 2 years of financial experience or 1 year of patient accounts experience.

Responsibilities

• Responsible for billing all third-party payers through claims processing.
• Identifies billing issues and ensures timely claim filing.
• Performs follow-up activities to resolve reimbursement issues.

Skills

Billing Competence

CPT Coding

ICD-9 Coding

HCPCS Coding

Claim Processing

Reimbursement Resolution

Education

High School Diploma

Tools

Epic Resolute

Job description

For application assistance, please email [e-mail]. Representatives are available Monday through Friday from 8 a.m. to 5 p.m. CST.

Minimum Qualifications:

High School Diploma or equivalent. Two years of financial experience or one year of patient accounts experience.

Licenses, Registrations, or Certifications:

High School Diploma or equivalent.

Preferred Qualifications:

These are agreed upon during the creation of a new posting with the hiring manager. They need to be verifiable (Example: Masters Degree, 5 years of experience).

Job Summary/Description:

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.

Job Duties:

1. Demonstrates a level of competence and understanding of all state and federal laws, rules and regulations regarding payer billing guidelines.
2. Demonstrates a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as POS requirements.
3. Billing payers and/or clients for hospital and/or Professional Patient Accounts.
4. Resolves Payer rejections from billing system daily to bill submit hospital and/or physicians claims.
5. Performs online corrections to edited claims according to procedures.
6. Performs detailed follow-up activities on assigned accounts according to procedures.
7. Responds to daily correspondence according to procedures.
8. Identifies denials and underpayments for appeal.
9. Reviews, researches and processes denied claims.
10. Appeal claims as appropriate according to policies and procedures.
11. Updates account information and documents as appropriate within Epic Resolute.
12. Processes account adjustments according to policies/procedures.
13. Issues payer and/or patient refunds according to policies/procedures.
14. Validates accuracy of payments and/or adjustments on accounts.
15. Resolves outstanding accounts at required accuracy and productivity requirements.
16. Maintains comprehensive knowledge of the work unit assigned.
17. Assists in the development of department policies and procedures.
18. Adheres to established policies and procedures.
19. Adheres to internal controls and reporting structure.
20. Maintains open and professional communication with customers, colleagues and vendors.
21. Performs well in a team environment.
22. Successfully completes competency based training and testing.
23. Prioritizes and completes all work in an accurate, effective and efficient manner.
24. Assists in the training and mentoring of new employees.
25. Reads all announcements and relevant communications relating to job duties.
26. Performs related duties as required.
27. Participates in team meetings/activities and supports the philosophy and goals of the team and department.

Salary Range:

Actual salary commensurate with experience or range if discussed and approved by hiring authority.

Work Schedule:

Partial remote, onsite position as needed. Position must be a Texas resident. 8am to 5pm, and as needed on occasion.

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 VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.

Primary Location

United States-Texas-Galveston

Work Locations

1022 - Bank of America Bldg, 301 University Blvd. Bank of America Bldg, rm 1.502, Galveston 77555-1022

Job

Business, Managerial & Finance

Organization

UTMB Health

Employee Status: Regular

Shift

Standard

Job Level

Non-Manager

Job Posting

Jan 13, 2025, 3:45:01 PM