Patient Account Specialist - RCO HB Follow Up | Galveston (Hybrid)

EDUCATION & EXPERIENCE:

Minimum Qualifications:

• Two years of financial experience or one year of patient accounts experience.

Preferred Qualifications:

• Expertise in Coding: Deep understanding of ICD-10, CPT, and HCPCS codes to correct mismatches and invalid codes.
• Claim Scrubbing Technology: Ability to use automated, real-time claim scrubbing tools to identify errors like missing patient data (DOB, sex) or invalid IDs before final submission.
• Software Proficiency: Familiarity with clearinghouse platforms (e.g., eMEDIX, Availity) and EHR/Practice Management systems to, for example, fix patient demographics at the root cause.
• Clearinghouse & Billing Software: Experience with platforms such as Availity, Change Healthcare, or TriZetto to monitor real-time claim statuses and perform batch edits.
• EDI (Electronic Data Interchange) Knowledge: Understanding X12 837 (claims) and 835 (remittances) file structures to identify "Loop" or "Segment" formatting errors.
• Regulatory Compliance: Mastery of HIPAA guidelines for handling Protected Health Information (PHI) and staying updated on payer-specific rules.
• Data Analysis: Ability to use Microsoft Excel to track rejection trends and identify systemic "root cause" issues in billing workflows.

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 ensure 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
• 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