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Sr. Patient Account Specialist - RCO HB Follow Up

Galveston, Texas, United States

New

Business, Managerial & Finance

UTMB Health

Requisition # 2600177

EDUCATION & EXPERIENCE:

Minimum Qualifications:

+ Associate’s degree or equivalent.

+ Minimum of three years patient accounts experience.

+ Minimum of two years Epic Revenue Cycle experience.

Preferred Qualifications:

+ Advanced experience with Epic Resolute PB/HB for managing high-balance A/R and claim edits.

+ Skilled in Epic Claim Edit Work queues, Error Pool, and Routing Logic for clean claim submission.

+ Proficient in Epic EDI Gateway workflows and troubleshooting clearinghouse rejections (Waystar/Availity/Change Healthcare).

+ Strong knowledge of Epic Reporting Workbench and Clarity for denial analytics and dashboards.

+ Ability to configure and optimize Epic work queues, scrubber rules, and routing for efficiency.

+ Familiarity with Epic Charge Review, coding edits, and compliance requirements.

JOB SUMMARY:

The Sr. 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 an expert 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

+ Meets or exceeds QA and Productivity 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

+ Assists in the training and mentoring of new employees

+ Performs quality assurance reviews

+ Assist in the coordination of reporting and feedback to stakeholders

+ 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:

On-site, full-time, 40 hours per week.

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.

Compensation