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.
- 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-10, HCPCS, modifier coding as well as documented guidelines
- Meets or exceeds QA and Productivity requirements
- Develops and maintains a close working relationship with Billing Compliance team to ensure documentation issues, patterns, and/or trends are promptly identified and addressed by prospective compliance education in a timely manner.
- 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
Detail oriented individual who is knowledgeable with advanced Excel (filter, pivot, sort, etc.).
Monday through Friday, 8:00am to 5:00pm
Actual salary commensurate with experience
High School Diploma or equivalent. Two years of financial experience or one year of patient accounts 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.
Primary Location United States-Texas-Galveston
Work Locations 1076 – Shearn Moody Plaza 301 University Blvd. Shearn Moody Plaza, rm 3.011 Galveston 77555 – 1076
Job Business, Managerial & Finance
Organization Univ. of Texas Medical Branch
Employee Status Non-Manager
Job Level Day Job
Job Posting Jan 14, 2021, 9:51:43 AM