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Patient Account Specialist

4 months ago

Galveston, United States UTMB Health Full time

**Minimum Qualifications**:
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 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
- Review, 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
- 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 Duties**:

- 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.

**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.