Senior Patient Account Specialist - Revenue Cycle HB Billing & Denials **Galveston, Texas, United States** **New** Business, Managerial & Finance UTMB Health Requisition # 2501160 **Minimum Qualifications:** Associate degree or equivalent. Minimum of three years patient accounts experience. Minimum of two years Epic Revenue Cycle experience **Job Description:** 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 insure 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. + Meets 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, 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. **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. + 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