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Patient Account Specialist - RCO PB Follow Up
<div><p><strong>EDUCATION & EXPERIENCE:</strong></p><p><strong>Minimum Qualifications:</strong></p><ul><li>Two years of financial experience or one year of patient accounts experience. </li></ul><p><strong>Preferred Qualifications:</strong></p><ul><li>Experience with Epic systems. </li><li>Experience managing Medicaid and Managed Medicaid hospital claim denials and follow-up.</li></ul><p><strong>JOB SUMMARY:</strong></p><p>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.</p><p><strong>ESSENTIAL JOB FUNCTIONS:</strong></p><ul><li>Demonstrates a level of competence and understanding of all state and federal laws, rules, and regulations regarding payer billing guidelines</li><li>Demonstrates a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as POS requirements</li><li>Billing payers and/or clients for hospital and/or Professional Patient Accounts</li><li>Resolves Payer rejections from billing system daily to bill submit hospital and/or physicians claims</li><li>Performs online corrections to edited claims according to procedures</li><li>Performs detailed follow-up activities on assigned accounts according to procedures</li><li>Responds to daily correspondence according to procedures</li><li>Identifies denials and underpayments for appeal</li><li>Reviews, researches, and processes denied claims</li><li>Appeal claims as appropriate according to policies and procedures</li><li>Updates account information and documents as appropriate within Epic Resolute</li><li>Processes account adjustments according to policies/procedures</li><li>Issues payer and/or patient refunds according to policies/procedures</li><li>Validates accuracy of payments and/or adjustments on accounts</li><li>Resolves outstanding accounts at required accuracy and productivity requirements</li><li>Maintains comprehensive knowledge of the work unit assigned</li><li>Assists in the development of department policies and procedures</li><li>Adheres to established policies and procedures</li><li>Adheres to internal controls and reporting structure</li><li>Maintains open and professional communication with customers, colleagues, and vendors</li><li>Performs well in a team environment</li></ul><p><strong>Marginal or Periodic Functions:</strong></p><ul><li>Successfully completes competency-based training and testing</li><li>Prioritizes and completes all work in an accurate, effective, and efficient manner</li><li>Participates in team meetings/activities and supports the philosophy and goals of the team and department</li><li>Assists in the training and mentoring of new employees</li><li>Reads all announcements and relevant communications relating to job duties</li><li>Performs related duties as required.</li></ul><p><strong>WORKING ENVIRONMENT/EQUIPMENT:</strong></p><ul><li>Standard hospital, clinical, laboratory and/or office environments.</li><li>Standard office equipment.</li></ul><p><strong>SALARY RANGE:</strong></p><p>Actual salary commensurate with experience.</p><p><strong>WORK SCHEDULE:</strong></p><p>Mostly Remote, Monday through Friday, 8-hour shifts scheduled within hours of operation of 6:00 AM to 6:00 PM, and as needed on occasion.</p><p> </p><p> </p><p><strong>Equal Employment Opportunity</strong></p><p>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.</p></div>
