Billing Specialist

Office Location
The University of Texas Rio Grande Valley
1201 W. University Drive
Human Resources
MASS Building 2 nd Floor
Edinburg, TX 78539

Edinburg:
Brownsville:

Office hours:
Monday-Friday
8:00a.m.

- 5:00p.m.

Faculty Recruitment:
College of Engineering & Computer Science: cecs

Robert

C. Vackar College of Business & Entrepreneurship: cobe

Posting Number SRGV
7086

Working Title BILLING SPECIALIST I

Number of Vacancies 1

Department School of Medicine / Clinical Affairs

FTE 1.0

FLSA Non-Exempt

Facilitate the revenue cycle process following patient accounts through entire billing process from registration to charge entry to completion of payment process working within UT Health RGV EMR /Practice Management system and with contracted billing agency.

• Works closely with Revenue Cycle team, clinics, physicians, departments, and contracted billing agency to resolve issues with insurance companies regarding incorrect registration information, claims processing, coding issues, and AR payments or denials.
• Responsible for accurate and timely resolution of preparing professional billing claims and working clearinghouse edits. This includes working Missing Slips and Billholds, verifying insurances as needed, obtaining referral information and authorizations for encounters as required by payers.
• Responsible for working pre-payer rejections and denials and ensuring billing deadlines are not missed. This includes ensuring referrals and authorizations are entered/obtained by clinics for all Medicaid Managed Care plans and/or HMO plans. Educating clinic staff based on pre- payer rejections/denials as applicable.
• Provides customer service to patients by addressing their questions, concerns or complaints. Able to assist patients with questions on their patient balance, payment arrangements, or insurance inquiries. Educates patients and clinic staff on insurance policies and insurance billing/collection procedures.
• Works with physicians and clinic staff to ensure that charts are closed and signed appropriately so coding can be completed and bills can be submitted. Verifies that CPT codes and diagnosis are entered in patient billing and/or clarifies codes as needed in PM system. Assists clinic staff with CPT codes so clinic can obtain prior authorization or communicates with clinic staff to contact payers when codes are changed based on actual procedures done on patient.
• Responsible for registering patient accounts where interfaces are not in place with UT Health partners. This includes entering demographic and insurance information, verifying insurance, entering referral information and/or prior authorization, posting charges and/or payments for clinic visits and/or hospital services. Responsible to assist clinics on patient responsibilities based on Fee Schedule and/or assisting them in finding the correct CPT code to determine patient responsibility.
• Responsible for posting payments and adjustments on patient accounts. Reconciling payment/adjustment batches daily.
• Assists clinics on completing their daily deposits information and ensures their deposit batches are reconciled daily.
• Maintains working day-to-day knowledge of electronic health record ( EHR ) and Practice Management (PM) system.
• Follows up and thoroughly researches reason for (post) denied claims and works appeals as necessary to resolve outstanding balances. Ensures appeal deadlines with payers are not missed.
• Identifies and documents new payer denial trends and notifies supervisor for escalated follow-up.
• Performs root cause analysis and identifies edit trends timely to minimize lag delays and maximize opportunities to improve processes.
• Demonstrates good judgment in escalating root causes and edit trends to leadership to ensure timely resolution.
• Communicates effectively with the Billing Specialist II and III and Compliance Specialist to handle accurate and timely resolution of coding-related claim edits and appeals.
• Runs billing, Accounts Receivable, denials, and any other Revenue Cycle reports as requested or needed.
• Assists in month end procedures and reporting.
• Assists with managing patient and payer credit balances following established Revenue Cycle policy and procedures.
• Performs other duties as assigned.

General supervision from assigned supervisor.

Direct supervision of assigned staff.

High school diploma or equivalent.

N/A

Certified Coding Associate (…