[Hiring] Patient Business Services Billing Specialist @UT MD Anderson Cancer Center

Role Description

The PBS Billing Specialist plays a critical role in supporting reimbursement processes, regulatory compliance, and financial stewardship. The PBS Billing Specialist ensures governmental claims are billed accurately and resolved efficiently, while contributing to the organization's mission by supporting essential revenue cycle functions.

Responsibilities

• Governmental Billing & Claims Processing
  • Bill and follow up on claims for Medicare, TRICARE, CHAMPVA, and other applicable governmental payers.
  • Submit claims within applicable filing deadlines and according to regulatory requirements.
  • Apply governmental payer billing guidelines to maximize reimbursement and support claim resolution.
  • Ensure billing activities are performed accurately, timely, and efficiently.
• Billing Expertise & Work Queue Management
  • Utilize working knowledge of UB-04 institutional claim forms, modifier logic, HCPCS/CPT codes, revenue codes, and billing requirements.
  • Complete claims assigned to daily billing work queues.
  • Ensure claims are accurate, complete, and submitted according to payer-specific requirements.
  • Apply governmental payer guidelines to all billing activities.
• Denial Resolution, Appeals & Account Follow-Up
  • Research, correct, and resolve Medicare Return to Provider (RTP) rejections and other governmental payer claim rejections.
  • Review and resolve daily claim response reports, rejection reports, and billing exception reports.
  • Analyze denial root causes and implement corrective actions to prevent recurring issues.
  • Prepare, submit, and follow up on appeals, reconsiderations, and payer dispute requests within filing deadlines.
  • Perform timely follow-up on assigned governmental accounts, aged trial balance accounts, work queues, and denial reports.
  • Continue account follow-up until final resolution is achieved.
• Communication, Compliance & Specialized Billing
  • Communicate with revenue cycle departments to resolve claim discrepancies and obtain required documentation.
  • Communicate with Medicare Administrative Contractors (MACs), fiscal intermediaries, TRICARE contractors, CHAMPVA representatives, and other governmental payer contacts.
  • Maintain current knowledge of Medicare bulletins, CMS regulations, MAC updates, TRICARE guidelines, CHAMPVA requirements, and other governmental payer policies.
  • Ensure compliant billing for CMS-qualified clinical trials and other specialized claims.
  • Notify management of billing errors, reimbursement delays, filing deadline risks, and payer processing issues.
• Documentation, Quality Assurance & Account Resolution
  • Document clear, concise, accurate, and complete collection notes for every account worked.
  • Record payer communications, claim status, denial reasons, actions taken, and required follow-up activities.
  • Review account history, billing transactions, system comments, and work output for quality and compliance.
  • Identify and resolve late charges, unbilled charges, and accounts pending billing.
  • Coordinate with appropriate departments to facilitate timely claim submission and reimbursement.
  • Perform other related hospital billing and collection duties as assigned.

Qualifications

• Required: Associate's Degree or equivalent college credit.
• Required: 5 years progressively responsible billing experience with three years in governmental hospital billing.
• Preferred: Hospital billing and collections for Medicare, TRICARE, CHAMPVA, and other applicable governmental payers.
• Preferred: Experience using Epic to research accounts, manage billing work-queues, resolve claim edits and denials, document collection activities, and monitor account resolution.
• Preferred: Ability to research complex billing issues, identify root causes, and implement appropriate corrective actions to prevent recurring denials and billing errors.

Benefits

• Employer-paid medical coverage starting day one for employees working 30+ hours/week, plus optional group dental, vision, life, AD&D, and disability insurance.
• Accruals for PTO and Extended Illness Bank, plus paid holidays, wellness, childcare, and other leave options.
• Tuition Assistance Program after six months of service and access to extensive wellness, fitness, and employee resource groups.
• Defined-benefit pension through the Teachers Retirement System, voluntary retirement plans, and employer-paid life and reduced salary protection programs.