Minimum Qualifications

Minimum Qualifications: Associate degree or equivalent. Minimum of three years patient accounts experience. Minimum of two years Epic Revenue Cycle experience

 

Job Description

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 insure 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, research, 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

 

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 goalsof 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.

 

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.

Compensation