Patient Account Specialist

GoHealth Urgent Care•Rochester, MN

About The Position

You’re more valuable than ever – And that’s just how we’ll make you feel. Summary The Patient Account Specialist is responsible for taking all inbound phone calls, researching customer issues, collecting customer information, collecting payments from customers, responding to all customer inquiries via fax/email/calls.

Requirements

High School Diploma or GED
3+ years of healthcare, billing, or service experience
This role is patient facing and involves interaction and collaboration with other departments and requires excellent judgment and interpersonal skills.
Strong interpersonal skills including sound judgement while working with cross functional departments.
Understanding of basic medical terminology and common healthcare documentation.
Highly experienced in Microsoft Excel and Word for data entry, reporting, and documentation.
Strong working knowledge of medical billing codes such as Current Procedural Terminology
(CPT) and International Classification of Diseases (ICD) coding for accurate billing and claims processing.
Exceptional phone and communication skills with the ability to interact effectively across departments and with customers.
Ability to organize and prioritize tasks efficiently in a fast-paced environment.
Proficient in navigating computer systems and performing mathematical calculations related to customer accounts and billing.
Ability to maintain strict customer confidentiality in compliance with HIPAA and company policies.
Demonstrated ability to follow through with customer inquiries and resolve issues with professionalism and sound judgment.
Demonstrate flexibility and open mindedness when approaching problem solving and adapting to changing workflows or priorities.
Ability to calculate deductibles and co-insurance accurately.
Ability to read and interpret Explanation of Benefits (EOBs).
Skilled in performing collection activities related to follow-up and account resolution.
Ability to identify under and overpayments from payors and take appropriate action.
Experience with third party payor portals for eligibility verification, claim status and account resolution.

Nice To Haves

3 years Medical Billing experience
CPAR – Certified Patient Account Representative
Associate’s degree in business administration or related field
Medical insurance billing and claims processing
Epic or eClinicalWorks experience
Bilingual (Spanish)

Responsibilities

Accurately update and maintain customer demographic and insurance information.
Update and document patient account clearly and thoroughly to include information received and given during patient interaction.
Conduct thorough review of patient accounts to verify that required documentation is properly scanned and recorded, ensuring no unnecessary or duplicate documentation requests are made.
Deliver high-level customer service to internal customers, payors and urgent care centers.
Provide exceptional service to customers, ensuring a positive and professional experience.
Manage each customer inquiry through resolution to include collaborating with internal teams as needed and ensuring timely follow-up.
Address service-related issues professionally when interacting with customers, guests, physicians and team members.
Communicate clearly with customers regarding medical and financial matters via phone, email and other communication channels.
Serve as an effective extension of Company urgent care centers, supporting their mission and values.
Maintain composure and focus while managing multiple tasks and customer interactions in a high-pressure environment.
Actively listen to patients to identify financial needs and assist with financial assistance applications when appropriate.
Minimize patient escalations through one-call resolution.
Responsible for collecting unpaid customer balances and assisting with credit card payments.
Provides effective review of accounts leading to patient collection of outstanding balances.
Documents and updates patient accounts information for all payment and contested balances.
Performs research and analysis of account issues to timely and accurately resolve accounts.
Ability to review an account and offer prompt pay discounts to increase collections.
Accurately and timely submit for patient adjustments to satisfy balances if applicable.
Accurately calculate customer deductibles and co-insurance amounts based on insurance plan details and service charges.
Review and interpret Explanation of Benefits (EOBs) from insurance carriers to ensure appropriate account handling and customer communication.
Reviews patient claims to articulate the reason for outstanding balances, including claim review, over/underpayment identification, claim non-submittal, contractual adjustments, deductibles and overall patient responsibility.
Ability to review claims and take appropriate action, including identifying why a claim denied and resubmitting for processing.
Validating commercial insurance, including patient eligibility, referrals and authorizations as necessary to secure carrier payment.
Maintain consistent daily communication with Team and Section leaders.
Share relevant information with team members to support collaboration and continuity of care.
Appropriately document any barriers in issue resolution and escalate as needed for review.
Assist colleagues with tasks and responsibilities when time permits.
Appropriately identify and assign tasks and responsibilities to internal departments when additional action is required.