Remote Patient Account Specialist: Denials & Follow-Up

Minimum Qualifications Two years of financial experience or one year of patient accounts experience. Preferred Qualifications Experience with Epic systems. Experience managing Medicaid and Managed Medicaid hospital claim denials and follow-up. Job Summary 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. They will identify billing issues affecting hospital and/or physician claims/accounts and take necessary action to ensure timely and appropriate claim filing. The role includes follow‑up activities and identification of reimbursement issues affecting these claims, with actions taken to ensure timely and appropriate reimbursement and account resolution. Essential Job Functions Demonstrates 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, and POS requirements. Bill payers and/or clients for hospital and/or professional patient accounts. Resolve payer rejections from billing system daily to bill submit hospital and/or physician claims. Perform online corrections to edited claims according to procedures. Perform detailed follow‑up activities on assigned accounts according to procedures. Respond to daily correspondence according to procedures. Identify denials and underpayments for appeal. Review, research, and process denied claims. Appeal claims as appropriate according to policies and procedures. Update account information and documents as appropriate within Epic Resolute. Process account adjustments according to policies and procedures. Issue payer and/or patient refunds according to policies and procedures. Validate accuracy of payments and/or adjustments on accounts. Resolve outstanding accounts at required accuracy and productivity requirements. Maintain comprehensive knowledge of the work unit assigned. Assist in the development of department policies and procedures. Adhere to established policies and procedures. Adhere to internal controls and reporting structure. Maintain open and professional communication with customers, colleagues, and vendors. Perform well in a team environment. Marginal or Periodic Functions Successfully complete competency‑based training and testing. Prioritize and complete all work accurately, effectively, and efficiently. Participate in team meetings/activities and support the philosophy and goals of the team and department. Assist in the training and mentoring of new employees. Read all announcements and relevant communications relating to job duties. Perform 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 Mostly remote, Monday through Friday, 8‑hour shifts scheduled within hours of operation of 6:00 AM to 6:00 PM, and as needed on occasion. 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 or 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 The University of Texas Medical Branch