Business, Managerial & FinanceUTMB HealthRequisition #: 2600677Education & Experience:Minimum Qualifications:Two years of financial experience or one year of patient accounts experience.Preferred Qualifications:2+ years of Medical Billing and Revenue Cycle Operations (Understanding of Claims, EOBs/Remits, Cash Posting, Eligibility/Registration, Coding)2+ years working with various payers (utilizing payer websites - obtaining claim status, provider manuals, policies & reimbursement methodologies)2+ years utilizing work queues and documenting account notes2+ years of analytical skills & problem solving (ability to critically think & identifying root causes and trends).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 ensure 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 guidelinesDemonstrates a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as POS requirementsBilling payers and/or clients for hospital and/or Professional Patient AccountsResolves Payer rejections from billing system daily to bill submit hospital and/or physicians claimsPerforms online corrections to edited claims according to proceduresPerforms detailed follow-up activities on assigned accounts according to proceduresResponds to daily correspondence according to proceduresIdentifies denials and underpayments for appealReviews, researches, and processes denied claimsAppeal claims as appropriate according to policies and proceduresUpdates account information and documents as appropriate within Epic ResoluteProcesses account adjustments according to policies/proceduresIssues payer and/or patient refunds according to policies/proceduresValidates accuracy of payments and/or adjustments on accountsResolves outstanding accounts at required accuracy and productivity requirementsMaintains comprehensive knowledge of the work unit assignedAssists in the development of department policies and proceduresAdheres to established policies and proceduresAdheres to internal controls and reporting structureMaintains open and professional communication with customers, colleagues, and vendorsPerforms well in a team environmentMarginal or Periodic Functions:Successfully completes competency-based training and testingPrioritizes and completes all work in an accurate, effective, and efficient mannerParticipates in team meetings/activities and supports the philosophy and goals of the team and departmentAssists in the training and mentoring of new employeesReads all announcements and relevant communications relating to job dutiesPerforms 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:On-site, Monday through Friday, 8-hour shifts with availability between 6 AM 6 PM.Equal Employment OpportunityUTMB 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.