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SalaryRequired Education/Experience:
High School Diploma or equivalent. Two years of financial experience or one year of Patient Accounts experience.
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 insure 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 guideline
- Demonstrates a basic understanding of CPT, IC-9, ICD-10, 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 Job 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.
Preferred Experience:
Epic System, Medicaid and Managed Medicaid Hospital Denials and Follow-up.
Salary Range:
Actual salary commensurate with experience.
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 VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.
