Patient Account Specialist - RCO HB Follow Up - Galveston (Hybrid)
The University of Texas Medical Branch, Galveston, TX, United States
Minimum Qualifications
Two years of financial experience or one year of patient accounts experience.
Preferred Qualifications
Expertise in Coding: Deep understanding of ICD-10, CPT, and HCPCS codes to correct mismatches and invalid codes.
Claim Scrubbing Technology: Ability to use automated, real-time claim scrubbing tools to identify errors like missing patient data (DOB, sex) or invalid IDs before final submission.
Software Proficiency: Familiarity with clearinghouse platforms (e.g., eMEDIX, Availity) and EHR/Practice Management systems to fix patient demographics at the root cause.
Clearinghouse & Billing Software: Experience with platforms such as Availity, Change Healthcare, or TriZetto to monitor real-time claim statuses and perform batch edits.
EDI (Electronic Data Interchange) Knowledge: Understanding X12 837 (claims) and 835 (remittances) file structures to identify "Loop" or "Segment" formatting errors.
Regulatory Compliance: Mastery of HIPAA guidelines for handling Protected Health Information (PHI) and staying updated on payer-specific rules.
Data Analysis: Ability to use Microsoft Excel to track rejection trends and identify systemic "root cause" issues in billing workflows.
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. The role identifies billing issues affecting hospital and/or physician claims/accounts and takes necessary action to ensure timely and appropriate claim filing. Responsibilities include performing follow‑up activities, identifying reimbursement issues, and ensuring timely and appropriate reimbursement and account resolution.
Essential Job Functions
Demonstrate a level of competence and understanding of all state and federal laws, rules, and regulations regarding payer billing guidelines.
Demonstrate a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as POS requirements.
Bill payers and/or clients for hospital and/or professional patient accounts.
Resolve payer rejections from the billing system daily to submit hospital and/or physician claims.
Perform online corrections to edited claims according to procedures.
Conduct 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 within Epic Resolute.
Process account adjustments according to policies/procedures.
Issue payer and/or patient refunds according to policies/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 in an accurate, effective, and efficient manner.
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 Hybrid, 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.
Location Galveston, Texas, United States
#J-18808-Ljbffr
Two years of financial experience or one year of patient accounts experience.
Preferred Qualifications
Expertise in Coding: Deep understanding of ICD-10, CPT, and HCPCS codes to correct mismatches and invalid codes.
Claim Scrubbing Technology: Ability to use automated, real-time claim scrubbing tools to identify errors like missing patient data (DOB, sex) or invalid IDs before final submission.
Software Proficiency: Familiarity with clearinghouse platforms (e.g., eMEDIX, Availity) and EHR/Practice Management systems to fix patient demographics at the root cause.
Clearinghouse & Billing Software: Experience with platforms such as Availity, Change Healthcare, or TriZetto to monitor real-time claim statuses and perform batch edits.
EDI (Electronic Data Interchange) Knowledge: Understanding X12 837 (claims) and 835 (remittances) file structures to identify "Loop" or "Segment" formatting errors.
Regulatory Compliance: Mastery of HIPAA guidelines for handling Protected Health Information (PHI) and staying updated on payer-specific rules.
Data Analysis: Ability to use Microsoft Excel to track rejection trends and identify systemic "root cause" issues in billing workflows.
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. The role identifies billing issues affecting hospital and/or physician claims/accounts and takes necessary action to ensure timely and appropriate claim filing. Responsibilities include performing follow‑up activities, identifying reimbursement issues, and ensuring timely and appropriate reimbursement and account resolution.
Essential Job Functions
Demonstrate a level of competence and understanding of all state and federal laws, rules, and regulations regarding payer billing guidelines.
Demonstrate a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as POS requirements.
Bill payers and/or clients for hospital and/or professional patient accounts.
Resolve payer rejections from the billing system daily to submit hospital and/or physician claims.
Perform online corrections to edited claims according to procedures.
Conduct 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 within Epic Resolute.
Process account adjustments according to policies/procedures.
Issue payer and/or patient refunds according to policies/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 in an accurate, effective, and efficient manner.
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 Hybrid, 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.
Location Galveston, Texas, United States
#J-18808-Ljbffr