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:

• Advanced experience with Epic Resolute PB/HB for managing high-balance A/R and claim edits.
• Skilled in Epic Claim Edit Work queues, Error Pool, and Routing Logic for clean claim submission.
• Proficient in Epic EDI Gateway workflows and troubleshooting clearinghouse rejections (Waystar/Availity/Change Healthcare).
• Strong knowledge of Epic Reporting Workbench and Clarity for denial analytics and dashboards.
• Ability to configure and optimize Epic work queues, scrubber rules, and routing for efficiency.
• Familiarity with Epic Charge Review, coding edits, and compliance requirements.

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 and feedback to stakeholders
• 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 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.

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, full-time, 40 hours per week.