Patient Account Specialist

Qualifications

Required Experience

5–7 years of experience in: 
Medical collections 
Healthcare revenue cycle 
Hospital accounts receivable (A/R) 
Government insurance follow-up 
Experience with Medicare billing processes and appeals 
Preferred Background

Previous experience with: 
Medicare/Medicaid collections 
Recovery Audit Contractor (RAC) processes 
Insurance claims processing 
Healthcare billing systems and collections software 
Technical Skills

Strong understanding of: 
CMS regulations 
Medical billing and reimbursement practices 
Appeals and denials management 
Proficiency with Microsoft Office, including Word and Excel 
Strong analytical, organizational, and communication skills 
Education

College coursework, healthcare billing certification/training, or insurance claims experience may be considered in lieu of direct hospital experience

Key Responsibilities

Medical Collections & Account Resolution

Manage and resolve assigned patient accounts through effective collection activities and follow-up efforts 
Perform collections on government and third-party payer accounts while adhering to all applicable state and federal regulations 
Ensure accurate and timely documentation of account activity within collection systems 
Handle inbound calls from patients, insurance carriers, and external partners professionally and efficiently 
Research and resolve account discrepancies, denials, payment variances, and claim issues 
Validate claim payments to ensure reimbursement aligns with contract and payment methodology guidelines 
Meet or exceed established productivity, quality, and recovery goals 
Government Insurance & Medicare Support

Maintain working knowledge of Medicare/Medicaid billing, collections, appeals, and reimbursement guidelines 
Process Medicare Redeterminations, Reopenings, and Reconsiderations as needed 
Correct claims in RTP status according to Medicare guidelines 
Support recovery audit and appeals processes related to government insurance claims 
Research and reference CMS and Medicare regulations when resolving account issues 
Collaboration & Customer Service

Partner with internal departments to obtain documentation needed for appeals and claim resolution 
Promote positive patient and client relationships through professional and respectful communication 
Ensure compliance with organizational policies and healthcare industry regulations 
Assist with special projects and operational initiatives as assigned