Patient Account Specialist - RCO HB Follow Up; Hybrid Remote

Patient Account Specialist - RCO HB Follow Up (Hybrid Remote)

** Galveston, Texas, United States*
* ** New*
* Business, Managerial & Finance

UTMB Health

Requisition # 2603744

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* EDUCATION & EXPERIENCE:

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* Minimum Qualifications:

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* + Two years of financial experience or one year of patient accounts experience.

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* Preferred Qualifications:

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* + 1+ year of experience in Medical Billing and/or Revenue Cycle Operations (working knowledge of claims processing, EOBs/remittance, cash posting, eligibility verification, patient registration, and/or medical coding).

+ 1+ year of experience working with various insurance payers, including navigating payer portals to obtain claim status, access provider manuals, and interpret reimbursement policies and methodologies

+ 1+ year of experience utilizing work queues and documenting account notes within a healthcare billing or patient accounting system

+ 1+ year of experience applying analytical and problem-solving skills, including the ability to critically evaluate data, identify root causes, and recognize trends.

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* JOB SUMMARY:

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* 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.

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* ESSENTIAL JOB FUNCTIONS:

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* + 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

+ 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.

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* WORK SCHEDULE:

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* Monday - Friday, availability required between 6:00 AM - 6:00 PM.

Hybrid schedule: initial training period conducted onsite (up to 4 weeks); following training, onsite presence required a minimum of 1 day per month.

** 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