Sr. Patient Account Specialist - RCO HB Follow Up

Minimum Qualifications Associate’s degree or equivalent. Minimum of three years patient accounts experience. Minimum of two years Epic Revenue Cycle experience.

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

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.

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.

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