Sr. Patient Account Specialist - RCO HB Follow Up

Educational & 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: Role-Specific Experience: Two to three years of hands-on experience in medical billing, revenue cycle, or claims denial management in a hospital (HB) or large clinical setting.
  Insurance Knowledge: Working knowledge of commercial insurance, Medicare, Medicaid, and Texas-specific managed care guidelines.
  Denial Processes: Demonstrated ability to identify, appeal, and resolve complex claim denials (e.g., underpayments, medical necessity rejections, and bundling issues).
  Coding: Proficiency in navigating medical coding sets, including ICD-10, CPT, and HCPCS.
  Analytical Skills: Experience investigating denial root causes (e.g., coding errors, medical necessity, timely filing limits) and drafting formal appeals.

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
• Maintains comprehensive knowledge of the work unit assigned
• Performs quality assurance reviews
• 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

• Succeeds in 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

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 AM - 5 PM.