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

Minimum of three years patient accounts experience. Minimum of two years Epic Revenue Cycle experience. Preferred Qualifications: Experience: 1 to 3+ years of experience in a healthcare billing, revenue cycle, or medical collections environment. Payer Knowledge: Strong understanding of Medicare, Medicaid, and major commercial insurance claim filing guidelines. Payer Portals: Experience actively utilizing insurance web portals to check claim statuses, provider manuals, and reimbursement methodologies. Additional Experience : Coding: Proficiency in navigating medical coding sets, including ICD-10, CPT, and HCPCS. Analytical Skills: Aptitude for 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 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 Assists in the training and mentoring of new employees Performs quality assurance reviews Assist 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 #J-18808-Ljbffr Utmb