Sr. Patient Account Specialist - RCO HB Follow Up

Sr. Patient Account Specialist - RCO HB Follow Up Galveston, Texas, United States Business, Managerial & Finance UTMB Health Requisition # 2603085

EDUCATION & EXPERIENCE:

Minimum Qualifications: Associate’s degree or equivalent. Minimum of three years patient accounts experience. Minimum of two years Epic Revenue Cycle experience. Preferred Qualifications: Role-Specific Experience: Two to three years of hands‑on experience in medical billing, revenue cycle, or claims denial management in a hospital (HB) or large clinical setting. Insurance Knowledge: Working knowledge of commercial insurance, Medicare, Medicaid, and Texas‑specific managed care guidelines. Denial Processes: Demonstrated ability to identify, appeal, and resolve complex claim denials (e.g., underpayments, medical necessity rejections, and bundling issues). Coding: Proficiency in navigating medical coding sets, including ICD-10, CPT, and HCPCS. Analytical Skills: Experience investigating denial root causes (e.g., coding errors, medical necessity, timely filing limits) and drafting formal appeals.

JOB SUMMARY:

The Sr. 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.

ESSENTIAL JOB FUNCTIONS:

Demonstrates an expert 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. Meets or exceeds QA and productivity 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. Appeals 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. Assists in the training and mentoring of new employees. Performs quality assurance reviews. Assists in the coordination of reporting and feedback to stakeholders. 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.

WORK SCHEDULE:

On‑site, Monday through Friday, 8 AM - 5 PM. 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. #J-18808-Ljbffr UTMB Health