Patient Account Specialist - RCO HB Follow Up (Hybrid Remote)

Patient Account Specialist - RCO HB Follow Up (Hybrid Remote)

Galveston, Texas, United States

Education & Experience
Minimum Qualifications

Two years of financial experience or one year of patient accounts experience.

Preferred Qualifications

1+ year of experience in Medical Billing and/or Revenue Cycle Operations (working knowledge of claims processing, EOBs/remittance, cash posting, eligibility verification, patient registration, and/or medical coding).

1+ year of experience working with various insurance payers, including navigating payer portals to obtain claim status, access provider manuals, and interpret reimbursement policies and methodologies.

1+ year of experience utilizing work queues and documenting account notes within a healthcare billing or patient accounting system.

1+ year of experience applying analytical and problem‑solving skills, including the ability to critically evaluate data, identify root causes, and recognize trends.

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

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 billing system daily to bill submit hospital and/or physicians 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 document as appropriate 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
Monday - Friday, availability required between 6:00 AM – 6:00 PM.

Hybrid schedule: initial training period conducted onsite (up to 4 weeks); following training, onsite presence required a minimum of 1 day per month.

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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