Patient Account Specialist - RCO HB Follow Up (Hybrid Remote | Galveston)

Education & Experience

Minimum Qualifications: Two years of financial experience or one year of patient accounts experience.

Preferred Qualifications: Expertise in Coding: Deep understanding of ICD-10, CPT, and HCPCS codes to correct mismatches and invalid codes.
Claim Scrubbing Technology: Ability to use automated, real-time claim scrubbing tools to identify errors like missing patient data (DOB, sex) or invalid IDs before final submission.
Software Proficiency: Familiarity with clearinghouse platforms (e.g., eMEDIX, Availity) and EHR/Practice Management systems to, for example, fix patient demographics at the root cause.
Clearinghouse & Billing Software: Experience with platforms such as Availity, Change Healthcare, or TriZetto to monitor real-time claim statuses and perform batch edits.
EDI (Electronic Data Interchange) Knowledge: Understanding X12 837 (claims) and 835 (remittances) file structures to identify "Loop" or "Segment" formatting errors.
Regulatory Compliance: Mastery of HIPAA guidelines for handling Protected Health Information (PHI) and staying updated on payer-specific rules.
Data Analysis: Ability to use Microsoft Excel to track rejection trends and identify systemic "root cause" issues in billing workflows.

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.

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.

Maintains comprehensive knowledge of the work unit assigned.

Affords assistance 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.

Affords assistance 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.