Billing Specialist - Patient Account Representative

Billing Specialist - Patient Account Representative

We are seeking a highly organized and detail-oriented Billing Specialist-Pt Account Rep to support accurate and efficient revenue cycle operations. This role plays a critical part in managing patient accounts by ensuring timely resolution of outstanding patient balances, supporting account reconciliation, coordinating insurance and patient payment activity, and assisting with legacy account cleanup during system transitions. The ideal candidate is customer-service driven, detail-oriented, and experienced in patient financial services, payment arrangements, insurance coordination, and account resolution while maintaining a strong commitment to accuracy, compliance, and continuous process improvement.

Our Values:

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Review and resolve outstanding patient and insurance accounts by researching discrepancies, resolving claim issues and denials, contacting patients regarding outstanding balances, answering billing questions, and establishing payment arrangements to facilitate timely account resolution.
• Maintain a strong understanding of payer policies, VBC metrics, RAF/HCC coding relevance, and risk adjustment impacts on reimbursement.
• Review and resolve outstanding accounts receivable (AR) and insurance denials by analyzing claims, researching discrepancies, and submitting appeals as needed.
• Prepare, review, and submit clean medical claims for primary and secondary payers, including Medicare Advantage, Medicaid Managed Care, and commercial insurers as needed.
• Collaborate with internal departments and payers to identify root causes of denials and ensure timely resolution and reimbursement.
• Maintain patient confidentiality and demonstrate professionalism and empathy when discussing sensitive financial matters.
• Support audits, data clean-up initiatives, and quality reporting related to billing.
• Ensure compliance with HIPAA and all regulatory requirements.

Qualifications

• High school diploma or equivalent required; associate degree or billing certification (e.g., CPB, CMRS, CBCS) preferred.
• At least 2 years of medical billing experience in a multi-specialty or primary care setting preferred.
• Experience with Medicare Advantage, HMO, PPO, and/or value-based payment models strongly preferred.
• Familiarity with EMR and billing software (e.g., eClinicalWorks, Athena, NextGen, Kareo).
• Working knowledge of CPT, ICD-10, HCPCS, and modifier usage.
• Strong attention to detail, organizational skills, and follow-through.
• Excellent communication and teamwork skills.

Environmental Job Requirements and Working Conditions

• Scheduling options: 7:30 AM 4:00 PM or 8:00 AM 4:30 PM with a 30-minute lunch between 12:001:00 PM.
• The total compensation range for this role is $19$22/hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at View email address on click.appcast.io to request an accommodation.