Patient Account Specialist

Review professional and institutional claims for accuracy, completeness, coding consistency, authorization status, and payer requirements Validate patient, provider, insurance, coding, and billing information for clean claim submission and accurate reimbursement Research and resolve claim edits, clearinghouse rejections, denials, underpayments, unpaid claims, billing discrepancies, and reimbursement issues Prepare and submit corrected, replacement, voided, and appealed claims according to payer guidelines and timely filing requirements Follow up on outstanding insurance and patient balances through final account resolution Research payer policies, reimbursement guidelines, and claim requirements using payer portals and available resources Review remittance advice, claim history, account documentation, and billing records to identify root causes and resolve payment issues Identify recurring denial trends and reimbursement issues, escalating process‑improvement opportunities to leadership Maintain accurate and timely documentation of account activity within the billing system Comply with organizational policies and regulatory requirements and perform other assigned duties Work under the supervision of the Manager of Patient Accounts Requirements 2–5 years of experience in patient accounts, insurance follow‑up, denial management, healthcare billing, or revenue cycle operations Experience with Medicare and/or Medicaid professional and institutional billing preferred Strong knowledge of claims processing, accounts receivable, appeals, denial management, payer reimbursement guidelines, and outpatient reimbursement methodologies Working knowledge of CPT, HCPCS, ICD‑10 coding, NCCI edits, medical necessity, and authorization requirements Experience using billing systems, clearinghouse platforms, and payer portals Experience with Raintree, Waystar, Inovalon, Wellpoint Federal, and ePaces preferred Strong analytical, organizational, and problem‑solving skills with exceptional attention to detail Ability to interpret remittance advice, claim status responses, and payer correspondence Proficiency in Microsoft Office Excellent communication and customer service skills Ability to build positive relationships with patients, payers, and colleagues Ability to prioritize competing deadlines while maintaining accuracy and meeting timely filing requirements Demonstrates expertise in claims processing, denial management, and healthcare billing, with a strong focus on accuracy and compliance with payer guidelines. Proficient in utilizing billing systems and analyzing reimbursement issues to ensure timely and accurate claim submissions. Highest‑signal resume keywords Claims Processing Denial Management Healthcare Billing CPT, HCPCS, ICD‑10 Coding Billing Systems Experience Hard Skills Claims Processing Denial Management Healthcare Billing CPT Coding HCPCS Coding ICD‑10 Coding Payer Reimbursement Guidelines Accounts Receivable Appeals NCCI Edits Soft Skills Analytical Skills Organizational Skills Problem‑Solving Skills Attention to Detail Communication Skills Customer Service Skills Industry Keywords Patient Accounts Insurance Follow‑Up Revenue Cycle Operations Payer Policies Reimbursement Guidelines Tools & Technologies Billing Systems Clearinghouse Platforms Payer Portals Raintree Waystar Inovalon Wellpoint Federal EPaces Microsoft Office #J-18808-Ljbffr Jobtailor