Senior Patient Account Specialist - RCO HB 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+ 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 notes, 2+ years of analytical skills & problem solving (ability to critically think & identifying root causes and trends).

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
• Mets 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
• Appeals 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
• Affords assistance in the coordination of reporting and feedback to stakeholders
• 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

• Succesfully 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 in Galveston (on-site expectations: as scheduled for departmental needs). Monday through Friday, 8-hour shifts with availability between 6 AM - 6 PM.