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

University of Texas Medical Branch (UTMB)•Galveston, TX

9d•Hybrid

About The Position

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.

Requirements

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

Nice To Haves

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 missingpatient 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.

Responsibilities

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
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.