Patient Account Specialist - RCO PB

Job Title

Patient Account Specialist – RCO PB Follow‑Up

Galveston, TX – 1022 – Bank of America Bldg, United States, Texas, Galveston

The Patient Account Specialist will be responsible for billing all third‑party payers through a claims processing vendor and for appeal of denied professional and/or hospital claims. Identifies billing issues affecting hospital and/or physician claims/accounts and takes necessary action to ensure timely and appropriate claim filing.

• 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

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

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.