Patient Account Specialist

Job Description

Job Description

Patient Accounts Specialist

(Medicare Professional & Institutional Billing)

Full-Time | Hybrid
Base Salary: $23.35–$26.39/hour (commensurate with experience)

Hours: 8:00 am - 4:30 pm

Under the supervision of the Manager of Patient Accounts, the Patient Accounts Specialist manages Medicare professional and institutional accounts throughout the revenue cycle. This role is responsible for insurance follow-up, denial resolution, claim corrections, appeals, payment research, and account documentation to support accurate, timely reimbursement. The ideal candidate has strong knowledge of healthcare billing, payer requirements, and revenue cycle operations, with the ability to identify reimbursement issues, resolve complex claims, and recognize opportunities for process improvement.

• Review professional and institutional claims for accuracy, completeness, coding consistency, authorization status, and payer requirements.
• Validate patient, provider, insurance, coding, and billing information to ensure 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 in accordance with 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 determine root causes and resolve payment issues.
• Identify recurring denial trends and reimbursement issues, escalating opportunities for process improvement to leadership.
• Maintain accurate, timely documentation of all account activity within the billing system.
• Comply with organizational policies, regulatory requirements, and perform other duties as assigned.

• 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 is 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 with the ability to build positive relationships with patients, payers, and colleagues.
• Ability to prioritize competing deadlines while maintaining accuracy and meeting timely filing requirements.

Rest, Reset & Recharge: 2 weeks PTO; Sick time in accordance with state and local requirements; plus 6 major holidays.

Plan Ahead: Company-matched 401(k) available once eligibility requirements are met.

Commute Smart: Pre-tax transit and parking benefits through WageWorks.

Care for Your Crew: MetLife Pet Insurance with flexible plans and 24/7 telehealth support.

Play More, Pay Less: Exclusive discounts through PlumBenefits and LifeMart.

Equal Opportunity Employer, including Disabled/Veterans.