Billing Specialist - Patient Account Representative
About The Position
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
Requirements
- High school diploma or equivalent required
- 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.
Nice To Haves
- associate degree or billing certification (e.g., CPB, CMRS, CBCS) preferred.
Responsibilities
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
