Revenue Cycle Specialist (Hospital Billing, On-Site)

Job Description

The Revenue Cycle Specialist II is responsible for managing the billing process, including handling denials, insurance follow-ups, and appeals based on their tier level in a hospital setting. Ensures accurate and timely submission of claims, works to resolve outstanding balances, and communicates effectively with insurance companies to maximize reimbursement. Collaborates with team members and other departments to maintain compliance with industry regulations and organizational policies, contributing to the overall success of the revenue cycle. May mentor lower-level and newer team members.

Responsibilities

Perform routine follow-ups with payers to ensure timely reimbursement. Review plan guidelines against patient accounts to address claim processing delays effectively. Work on denial resolutions, including claims denied for medical necessity, incomplete documentation, or other issues. Collaborate with clinic staff, registration teams, coding professionals, and medical records staff to address denied claims and prepare accurate appeals. Extract patient treatment details from medical records and coordinate with coding staff to compose individualized appeal letters. Make recommendations to reduce denials by improving billing practices and edit creation. Review and verify all demographic and insurance information using available systems, payer websites, or phone contact with third-party payers. Maintain accurate and complete documentation of all billing and payer-related activities. Respond to inquiries from patients/guarantors, insurance carriers, or internal departments. Stay current with all payer-specific guidelines and industry regulations, including HIPAA compliance. Crosstrain in relevant departmental functions to provide coverage as needed. Resolve outstanding claims in a timely and accurate manner, adhering to departmental policies. Adhere to productivity and quality goals as assigned by the department. Maintain strict confidentiality in all aspects of work. Perform other duties as assigned by the supervisor or manager.

Qualifications

• Review and verify insurance information using technology, applications, payer websites, or by contacting third-party payers or guarantors
• Review adjudicated claims from Medicare, Medicaid, and commercial carriers for appropriate billing.
• Prepare and submit accurate insurance claims and appeals within required timeframes and in accordance with government and payer regulations.
• Analyze plan guidelines against patient accounts to identify and address claim processing delays
• Address denied claims, claims pended for medical necessity, and claims pending supporting documentation by collaborating with clinic, registration, medical records, and coding teams to complete appeals.
• Extract patient treatment information from medical records and work with coding staff to compose appeal letters.
• Make recommendations for billing edits and processes to reduce denials.
• Resolve outstanding claims promptly, adhering to department policies and procedures.
• Respond to inquiries from patients, insurance carriers, or internal departments via telephone or other forms of communication
• Stay current on payer-specific guidelines and regulations Cross-train in department functions to provide backup as needed.
• Assist with training new hospital billing clerks on institutional standards and guidelines.
• Identify workflow improvement opportunities and collaborate with management to implement changes.
• Ensure all work is performed with strict confidentiality. Handle high-level appeals, including preparing documentation and negotiating outcomes with insurance companies.
• Manage escalated claims with significant financial impact, such as underpayments or disputed claims.
• Conduct root cause analysis on recurring billing issues and recommend solutions.
• Collaborate with leadership to set goals and drive improvements in the revenue cycle.
• Participate in revenue cycle audits, focusing on compliance with Medicare and Medicaid requirements.
• Adhere to production and quality goals.
• Perform all other duties as assigned by supervisor or manager.

This position may require the ability to maintain the security and integrity of UT San Antonio and its infrastructure per Texas EO-GA-48.

About Us

The University of Texas at San Antonio (UT San Antonio) is a nationally recognized, top-tier public research university that unites the power of higher education, biomedical discovery and healthcare within one visionary institution. As the third-largest research university in Texas and a Carnegie R1-designated institution, UT San Antonio is a model of access and excellence - advancing knowledge, social mobility and public health across South Texas and beyond. UT San Antonio serves approximately 42,000 students in 320 academic programs spanning science, engineering, medicine, health, liberal arts, AI, cybersecurity, business, education and more. With 17,000 faculty and staff, UT San Antonio has been recognized by Forbes as one of America's Best Employers for Company Culture.


Benefits Overview

UT Health San Antonio offers an excellent benefits package for its employees. Employees who work at least 20 hours a week, with an appointment of at least 4.5 months, are eligible for benefits.


Medical - UT SELECT Medical insurance is offered free for employees and administered by Blue Cross and Blue Shield of Texas. Family members can be added to the plan through payroll deduction. Employees and their dependents can also receive discounted copays and coinsurance when using UT Health Physicians, a network of 800 premier physicians including more than 100 specialists. Employees receive $50,000 of group term life insurance and $50,000 of basic accidental death and dismemberment insurance for free, with options to purchase additional employee and dependent coverage for both at group rates.

Dental - Three dental insurance plan options are available for employees and their families through Delta Dental Insurance Company, two PPOs and one dental HMO plan. Both PPO plans allow employees to choose any licensed dentist.


Vision - Fully insured Vision Care benefits are offered by Superior Vision Services. Two vision plan options that offer either standard or enhanced vision benefits.

Disability - Employees can enroll in the Disability Insurance which provides income if a non-work related illness or injury prevents you from working.

FSAs - Employees can enroll in flexible spending accounts (FSAs) to set aside money from earnings before taxes for qualifying dependent day care expenses or out-of-pocket health care expenses.


Retirement - Employees are eligible for either the Teacher Retirement System (TRS) or the Optional Retirement Plan (ORP). TRS is a defined benefit retirement plan which UT Health matches employee contributions. ORP is for eligible faculty staff employees. Voluntary retirement programs are also available to invest before- or after-tax dollars with the choice of five quality retirement plan providers.


Time Off - A generous leave program offers multiple paid leave options:

• Front-loaded Paid Time Off: 128 to 208 hours (16 to 26 days) of Paid Time Off based on years of service, given at the start of each fiscal year. PTO may be prorated in year one based on date of hire.
• Extended Illness Bank: 8 hours (1 day) accrued per month which can be used for illness or injury after one day of Paid Time Off is taken.
• Paid Family Leave: Up to 240 hours (6 weeks) to care for a spouse, child, or parent after 6 months of consecutive employment.
• Holidays: 12 set paid holidays each year.

Discounts - Employees enjoy a range of discounts on services, tickets, and gym membership.

EEO Statement

UT Health San Antonio is an equal employment opportunity and affirmative action employer. It is our policy to promote and ensure equal employment opportunity for all individuals without regard to race, color, religion, sex, gender identity, national origin, age, sexual orientation, disability, or veteran status.