What are the responsibilities and job description for the Sr. Patient Account Specialist - Revenue Cycle PB Billing & Denials position at UTMB Health?
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.
