Senior Patient Account Specialist - RCO PB Follow-Up (Hybrid Remote)

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: * 2-3 years of EPIC PB Resolute experience. 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: Hybrid remote, Monday through Friday, 8 AM - 5 PM. 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.