Patient Billing Specialist

Northeast Orthopaedic Alliance PLLC•Springfield, MA

22d•Onsite

About The Position

The Patient Billing Specialist is responsible for managing patient billing and accounts receivable activities using the Athena EHR (athenahealth) system. This role ensures accurate and timely claim submission, payment posting, and follow-up to support efficient revenue cycle operations. The position works closely with internal teams, insurance carriers, and patients to resolve billing issues while maintaining compliance with payer guidelines and organizational standards.

Requirements

Strong understanding of medical billing terminology, including CPT, ICD-10, and HCPCS
Working knowledge of Medicare, Medicaid, and commercial insurance plans
High attention to detail with strong organizational and multitasking skills
Ability to analyze billing issues and resolve discrepancies effectively
Knowledge of HIPAA and healthcare compliance regulations required

Nice To Haves

Experience with Workers’ Compensation billing preferred
Prior experience with Athena EHR (athenahealth) billing modules preferred

Responsibilities

Manage assigned payer accounts receivable, ensuring claims over 120 days do not exceed 10% of total A/R
Submit, monitor, and follow up on insurance claims to resolve unpaid, underpaid, or denied claims
Verify patient demographics, insurance eligibility, and benefits
Process claims, payments, adjustments, and post payments from patients and insurance carriers, including EOBs and ERAs
Identify, research, and resolve billing discrepancies, denials, and underpayments
Manage Workers’ Compensation accounts when applicable, including payment posting, denial resolution, and communication with claims adjusters
Communicate professionally with insurance carriers, claims adjusters, and patients to resolve billing inquiries, including billing-related phone calls
Accurately document all billing activity within Athena EHR
Collaborate with front desk, clinical, and coding staff to ensure complete and accurate billing
Maintain compliance with HIPAA, payer requirements, and organizational policies
Meet established productivity, accuracy, and timeliness standards
Perform other billing-related duties as assigned