What are the responsibilities and job description for the Sr. Patient Account Specialist - Revenue Cycle HB Billing & Denials position at UTMB Health?
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
Salary Range
Actual salary commensurate with experience.
