Job Title

Patient Services Associate I - Denials

Agency

Texas A&M University Health Science Center

Department

Clinic Str Finance Centralized

Proposed Minimum Salary

Commensurate

Job Location

Bryan, Texas

Job Type

Staff

Job Description

What we want

The Patient Services Associate I reviews, analyzes, and resolves denied or underpaid insurance claims, ensuring timely reimbursement and identifying trends to reduce future denials.

What you need to know

Required Education and Experience

• High school diploma or equivalent combination of education and experience.

• Two years of related experience in clinical billing, claims processing, or accounts receivable.

Preferred Qualifications

• Four years of related experience in denial management, medical billing, coding, or revenue cycle operations.

• Experience with denial resolution processes.

• Experience with Epic EMR

• Extensive understanding of medical billing, insurance guidelines, and Texas Medicaid.

• Familiarity with electronic medical record systems, specifically Epic.

Knowledge, Skills, and Abilities

• Expertise in denial management, appeals processes, and claims resolution

• Knowledge of HIPAA guidelines and working knowledge of electronic medical record systems (such as Epic)

• Knowledge of word processing and Microsoft Excel spreadsheet applications

• Effective verbal and written communication skills

• Strong interpersonal, problem solving, and organizational skills

• Strong attention to detail and ability to utilize sound judgment

• Ability to work independently and cooperatively with others

Responsibilities

Denial Review and Resolution

• Reviews and analyzes denied or underpaid claims to determine root cause and appropriate resolution.

• Prepares and submits timely appeals, including gathering supporting documentation and medical records.

• Follows up with insurance companies on denied claims to ensure timely reconsideration and reimbursement.

• Corrects and resubmits claims as necessary in accordance with payer requirements.

• Documents all denial activities, actions taken, and outcomes in the billing system.

Denial Tracking and Reporting

• Monitors denial trends and identifies recurring issues impacting reimbursement.

• Maintains denial logs and prepares reports for management review.

• Communicates trends and recommends process improvements to reduce future denials.

Compliance

• Ensures compliance with payer guidelines, federal and state regulations, and organizational policies.

All positions are security-sensitive. Applicants are subject to a criminal history investigation, and employment is contingent upon the institution’s verification of credentials and/or other information required by the institution’s procedures, including the completion of the criminal history check.

Equal Opportunity/Veterans/Disability Employer.