Sr. Patient Account Specialist - RCO HB Follow Up

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:

• 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
• 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, 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
• Assists in the training and mentoring of new employees
• Performs quality assurance reviews
• Assist in the coordination of reporting an