Patient Account Specialist - RCO HB Follow Up | Galveston (Hybrid)

Patient Account Specialist - RCO HB Follow Up | Galveston (Hybrid)
Galveston, Texas, United States

New

Business, Managerial & Finance

UTMB Health

Requisition # 2603689

EDUCATION & EXPERIENCE
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, for example, 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. 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 a 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

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

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.

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.

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