Patient Billing & Reimbursement Specialist

umchealthsystem; United States; On-site; USD 42,000 - 60,000; Full time

Job summary

UMC Health System in Texas is seeking a detail-oriented Billing Specialist to manage in-network and out-of-network accounts, ensure timely reimbursements, and adhere to payer rules. This role requires strong communication, accuracy, and knowledge of MTALA requirements.

You will handle contract knowledge, coding, and documentation, and coordinate with payers and internal teams to maintain cash flow while ensuring compliance with regulations.

Qualifications

• High school diploma or equivalent required.
• Some college preferred.
• Experience with third-party payer rules and MTALA knowledge helpful.

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 strides 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 and written communication

Computer skills

Basic accounting

Technical problem-solving

Adaptability

Education

High school diploma or equivalent

Some college

Job description

UMC Health System in Texas is seeking a detail-oriented Billing Specialist to manage in-network and out-of-network accounts, ensure timely reimbursements, and adhere to payer rules. This role requires strong communication, accuracy, and knowledge of MTALA requirements.

You will handle contract knowledge, coding, and documentation, and coordinate with payers and internal teams to maintain cash flow while ensuring compliance with regulations.