Patient Account Specialist - Revenue Cycle PB Billing & Denials **Galveston, Texas, United States** Business, Managerial & Finance UTMB Health Requisition # 2401606 **Minimum Qualifications:** High School Diploma or equivalent. Two years of financial experience or one year of patient accounts experience. **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 insure 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 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 • Review, 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 • Maintains comprehensive knowledge of the work unit assigned • Assists 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 Job Duties:** • 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 • Assists in the training and mentoring of new employees • Reads all announcements and relevant communications relating to job duties • Performs related duties as required. **Salary Range** Actual salary commensurate with experience. **Equal Employment Opportunity** UTMB 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 VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities. Compensation