BILLING SPECIALIST I

Posting Details
Position Information

Posting Number	SRGV7443
Working Title	BILLING SPECIALIST I
Number of Vacancies	1
Location	Rio Grande Valley
Department	School of Medicine/ Revenue Cycle
FTE	1.0
FLSA	Non-Exempt
Scope of Job	Facilitate the revenue cycle process following patient accounts through entire billing process from registration to charge entry to completion of payment process working within UT Health RGV EMR/Practice Management system and with contracted billing agency.
Description of Duties	• Works closely with Revenue Cycle team, clinics, physicians, departments, and contracted billing agency to resolve issues with insurance companies regarding incorrect registration information, claims processing, coding issues, and AR payments or denials. • Responsible for accurate and timely resolution of preparing professional billing claims and working clearinghouse edits. This includes working Missing Slips and Billholds, verifying insurances as needed, obtaining referral information and authorizations for encounters as required by payers. • Responsible for working pre-payer rejections and denials and ensuring billing deadlines are not missed. This includes ensuring referrals and authorizations are entered/obtained by clinics for all Medicaid Managed Care plans and/or HMO plans. Educating clinic staff based on pre- payer rejections/denials as applicable. • Provides customer service to patients by addressing their questions, concerns or complaints. Able to assist patients with questions on their patient balance, payment arrangements, or insurance inquiries. Educates patients and clinic staff on insurance policies and insurance billing/collection procedures. • Works with physicians and clinic staff to ensure that charts are closed and signed appropriately so coding can be completed and bills can be submitted. Verifies that CPT codes and diagnosis are entered in patient billing and/or clarifies codes as needed in PM system. Assists clinic staff with CPT codes so clinic can obtain prior authorization or communicates with clinic staff to contact payers when codes are changed based on actual procedures done on patient. • Responsible for registering patient accounts where interfaces are not in place with UT Health partners. This includes entering demographic and insurance information, verifying insurance, entering referral information and/or prior authorization, posting charges and/or payments for clinic visits and/or hospital services. Responsible to assist clinics on patient responsibilities based on Fee Schedule and/or assisting them in finding the correct CPT code to determine patient responsibility. • Responsible for posting payments and adjustments on patient accounts. Reconciling payment/adjustment batches daily. • Assists clinics on completing their daily deposits information and ensures their deposit batches are reconciled daily. • Maintains working day-to-day knowledge of electronic health record (EHR) and Practice Management (PM) system. • Follows up and thoroughly researches reason for (post) denied claims and works appeals as necessary to resolve outstanding balances. Ensures appeal deadlines with payers are not missed. • Identifies and documents new payer denial trends and notifies supervisor for escalated follow-up. • Performs root cause analysis and identifies edit trends timely to minimize lag delays and maximize opportunities to improve processes. • Demonstrates good judgment in escalating root causes and edit trends to leadership to ensure timely resolution. • Communicates effectively with the Billing Specialist II and III and Compliance Specialist to handle accurate and timely resolution of coding-related claim edits and appeals. • Runs billing, Accounts Receivable, denials, and any other Revenue Cycle reports as requested or needed. • Assists in month end procedures and reporting. • Assists with managing patient and payer credit balances following established Revenue Cycle policy and procedures. • Performs other duties as assigned.
Supervision Received	General supervision from assigned supervisor.
Supervision Given	Direct supervision of assigned staff.
Required Education	High school diploma or equivalent.
Preferred Education	N/A
Licenses/Certifications	Certified Coding Associate (CCA) preferred.
Required Experience	• Two (2) years of medical, hospital, or healthcare revenue cycle related experience, including thorough knowledge of registration, scheduling, pre-certification, prior authorizations, coding, claims billing, customer service, posting, collections, and/or reimbursement processes is required. or • One (1) year of billing experience with Certified Coding Associate (CCA)
Preferred Experience	Previous scheduling, registration, billing, coding, collections, and posting experience in a multi-specialty practice, healthcare facility, or ambulatory setting. Bilingual (English/Spanish)
Equipment	Use of standard office equipment.
Working Conditions	Needs to be able to successfully perform all required duties. Office Environment; some travel and weekend work is required. Must be familiar with CPT4, ICD10, HCPCs codes and use of modifiers. Ability to be flexible with assignments and multi-task as needed. Ability to demonstrate problem-solving skills in dealing with billing and collections related issues. Proficient use of computers and a working knowledge of Microsoft Office.
Other	Excellent verbal and written communication skills are required.
Physical Capabilities	N/A
Employment Category	Full-Time
Minimum Salary	Commensurate with Experience
Posted Salary	Commensurate with Experience
Position Available Date	04/01/2024
Grant Funded Position	No
If Yes, Provide Grant Expiration Date

Posting Detail Information

EEO Statement	It is the policy of The University of Texas Rio Grande Valley to promote and ensure equal employment opportunities for all individuals without regard to race, color, national origin, sex, age, religion, disability, sexual orientation, gender identity or expression, genetic information or protected veteran status. In accordance with the requirements of Title VII of the Civil Rights Act of 1964, the Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1990, as amended, our University is committed to comply with all government requirements and ensures non-discrimination in its education programs and activities, including employment. We encourage women, minorities and differently abled persons to apply for employment positions of interest.
Special Instructions to Applicants	Dear Applicant, Human Resources will not be held responsible for redacting any confidential information from the documents you attach with your application. The confidential information includes the following: *Date of Birth *Social Security Number *Gender *Ethnicity/Race Please make sure that you omit this information prior to submission. We are advising that Human Resources will be forwarding your application to the department as per your submission. If you have any questions, please visit our Careers site at https://careers.utrgv.edu for detailed contact information.
Additional Information	UTRGV is a distributed location institution and working location is subject to change based on need. All UTRGV employees are required to have a criminal background check (CBC). Incomplete applications will not be considered. Substitutions to the above requirements must have prior approval from the VP of HR & Talent Development .
Quick Link	https://careers.utrgv.edu/postings/42243