patient accounts specialist

TEEMA Group

<div><h2 class="jobSectionHeader">Patient Account Specialist Senior</h2><h3 class="jobSectionHeader">
Role Summary</h3>
Take a senior-level seat in a high-performing medical collections unit where your expertise directly impacts the financial health of a premier healthcare system. As a Senior Patient Account Specialist, you will navigate the complexities of insurance reimbursement, identifying and resolving denied or underpaid claims with precision and speed. This role is perfect for a detail-oriented professional who enjoys solving financial puzzles and advocating for proper reimbursement through professional communication with payers, patients, and vendors. You will be a key contributor to maintaining the structural integrity of the accounts receivable process while ensuring world-class patient and client satisfaction.
Key Duties:<ul><li>
Revenue Recovery: Collect outstanding balances from commercial, governmental, and third-party payers to ensure full and proper reimbursement for medical services.</li><li>
Claims Resolution: Proactively identify denied or underpaid claims, implementing timely solutions and appeals within specific payer guidelines.</li><li>
Knowledge Leadership: Maintain an expert-level understanding of payer claims processing, appeal procedures, provider contracts, and various payment methodologies.</li><li>
Technical Proficiency: Utilize a deep understanding of standard billing forms, filing requirements, and Explanation of Benefits (EOB) while navigating online payer portals.</li><li>
Trend Analysis: Identify and communicate recurring issues or industry trends that impact account resolution and overall reimbursement efficiency.</li><li>
Comprehensive Account Management: Manage both active Accounts Receivable (AR) and Bad Debt (BD) inventory, ensuring all documentation is accurate and compliant with state and federal guidelines.</li><li>
Stakeholder Collaboration: Facilitate professional communication with patients, clients, and reimbursement vendors to resolve complex account issues.</li></ul><h3 class="jobSectionHeader">
Required Qualifications</h3><ul><li>
Experience: Strong professional background as a medical collection specialist with a proven track record of resolving complex healthcare accounts.</li><li>
Skills: Expert knowledge of medical collection work processes and insurance reimbursement cycles.</li><li>
Compliance: Ability to adhere strictly to all client, state, and federal collection guidelines.</li><li>
Medical Requirements: Must complete all required medical screenings prior to start.</li></ul><h3 class="jobSectionHeader">
Desired Qualifications</h3><ul><li>
Communication: Exceptional interpersonal skills with the ability to manage conflict and provide a high level of patient and client satisfaction.</li><li>
Analytical Ability: Strong skills in identifying reimbursement trends and navigating various payer payment methodologies.</li><li>
System Knowledge: Familiarity with TLRA collection unit processes or similar large-scale hospital billing systems.</li></ul><h3 class="jobSectionHeader">
Location and Work Type</h3><ul><li>
Setting: Hospital Corporate Office / TLRA Collection Unit</li><li>
Work Type: On-site</li><li>
Location: Lake Charles, LA</li><li>
Schedule: Monday &ndash; Friday (8-hour shifts)</li><li>
Education Note: High School Diploma/GED verification is no longer required for this specific role.</li></ul>
If you're interested, please reply to this advertisement or directly email your resume to me at DSalgado@teemagroup.com or by calling/texting (949) 295-5951. 
I strive to reply within 48 hours. Looking forward to connecting with you soon. Thank you!
#Workwolf</div>

Patient Account Specialist Senior

HealthRev Partners

<div>Job Summary: 
The RCM Specialist for Home Health &amp; Hospice plays a crucial role in ensuring the efficient and accurate processing of claims and patient accounts, contributing to the organization's financial health. They possess a comprehensive understanding of revenue cycle processes and demonstrate expertise in resolving complex claims and patient billing issues. 


Essential Duties and Responsibilities:
<ul>
<li>Lead and optimize the full revenue cycle process from billing the claim to final payment collection.</li>
<li>Collaborate with the RCM team to maintain a clean and compliant revenue cycle.</li>
<li>Generate claims accurately from EMR system to clearinghouse and monitor the claim following HRP standard protocol.</li>
<li>Resubmit claims corrected as needed and communicate issues that need to be resolved.</li>
<li>Communicate unbilled and billed claim holds to Team Leader or RCM Manager.</li>
<li>Analyze and resolve complex claims denials and appeals.</li>
<li>Investigate and address patient billing discrepancies and disputes.</li>
<li>Identify and implement strategies to improve revenue cycle performance as needed.</li>
<li>Collaborate with cross-functional teams to implement and manage assigned RCM accounts.</li>
<li>Participate in revenue cycle audits and compliance reviews (quality review checks).</li>
<li>Develop and maintain accurate and up-to-date documentation of all claims and patient accounts.</li>
<li>Provide training and support to other RCM team members.</li></ul> 


Key Performance Indicators (KPIs):
<ul>
<li>Clean claim rate &gt;95%</li>
<li>Aged AR &lt; 20% of total AR</li>
<li>Meets productivity expectation of 45 non-Medicare claims per day or 75 Medicare</li>
<li>Net collection rate of &gt;95%</li>
<li>Meets and passes 100% of quality review checks completed by RCM Manager</li></ul> 


Qualifications:
<ul>
<li>3&ndash;5 years of experience in revenue cycle management in the home health and hospice realm</li>
<li>Proficient in Microsoft Office Suite 365</li>
<li>Proficient in home health and hospice electronic health records (EHR) systems</li>
<li>Strong understanding of insurance billing and coding procedures</li>
<li>Excellent communication, problem-solving, and analytical skills</li>
<li>Ability to work independently and as part of a team</li>
<li>Proven track record of success in resolving complex claims and patient billing issues</li></ul> 


Benefits:
<ul>
<li>Competitive salary and comprehensive benefits package, including health insurance, dental insurance, vision insurance, paid time off, and 401k savings plan</li>
<li>Opportunity to work in a dynamic and growing healthcare organization</li>
<li>Professional development and training opportunities</li>
<li>Contribution to the organization's financial success and patient satisfaction</li></ul></div>

RCM Specialist- Home Health and Hospice

Kaweah Health

<div>Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive services in our acute care hospital, specialized health centers and clinics. Our eight-campus healthcare district has 613 beds and offers comprehensive health services across a broad continuum of care.
It takes a special person to work for Kaweah Health. We serve a region where the needs are great, which makes the rewards even greater. Every day, we care for people facing unique challenges and in need of healing. Throughout it all, our focus is to make a difference, and we do &mdash; in the health of our patients, our loved ones, and our community.
Benefits Eligible
Full-Time Benefit Eligible
Work Shift
Day - 8 Hour or less Shift (United States of America)
Department
8530 Patient Financial Services
Maintains complete and full knowledge of payer(s) assigned to ensure accurate billing and collection of the claims. Validates that the Kaweah Health is being reimbursed by the payer in accordance with government or contract terms.
QUALIFICATIONS
Education
Preferred: High school diploma or equivalent
Experience
Required: Prior Patient Accounting or admissions experience. Comparable medical billing education may be considered.
JOB RESPONSIBILITIES
Essential
Maintains complete and full knowledge of payer(s) assigned to ensure compliance of specific guidelines and rules, as well as ensuring the Kaweah Health is being reimbursed by the payer in accordance with governmental or contract terms. Is a resource to Finance division management regarding the assigned payer.
Brings any reimbursement or compliance concerns to the attention of the Patient Accounting Manager.
Utilizes computer systems and/or billing reports to review all patient registrations or admissions for demographic information, appropriate financial class, insurance company and plan, and charges. 100% accuracy of this information is required to ensure proper recording of revenue, necessary authorizations are obtained, payer classification, correct billing of patient account, and other statistical indicators. Brings any unresolved issues to the attention of their manager.
Audits unbilled reports for potential holdups of patient accounts. Works closely with Medical Records on coding issues, Insurance Verification Clerk on insurance issues and other departments as necessary.
Completes billing process. Ensures all charges are accurate and appropriate. Payer guidelines will be followed during the billing process. After billing has been completed, uses appropriate charge description master (CDM) number to identify the payer and when the account was billed. Works closely with departments on unresolved issues.
Reviews and researches patient account credits and refunds as appropriate to patient and/or payer. For governmental payers, has the credit retracted.
Receives all correspondence and inquiries related to patient accounts and payer contract for which they are responsible. Answers mail and take appropriate action within specified timeframe.
Bills any secondary payers, change financial classes accordingly and sends appropriate collection system letter to patient for co-pays and deductibles owed, denied services, amounts applied to deductible, etc. Uses correct CDM code to identify what secondary payer was billed and when.
Reviews and works aging reports to identify unpaid patient accounts. Follows up with payers for timely reimbursement.
Works to ensure that days in accounts receivable goals are met maintained and/or lowered. Maintains job productivity and quality standards on a consistent basis as established by division management.
Answers phones as a back up to other departmental staff. Takes messages or routes calls as appropriate. As back up, assists customers at the service counter.
Conforms with patient confidentiality standards.
Demonstrates the knowledge and skills necessary to provide care and services appropriate to the population served on the assigned unit or work area.
Performs other duties as assigned.
Addendum (essential for specific dept)
Insurance or managed care payer:
Has complete knowledge of assigned insurance payer, knows contract terms, requirements and payment practices.
Receives prior day's explanation of benefits or remittance advices for assigned payer(s). Reviews to ensure that appropriate contractual adjustments have been taken by payer. Works closely with payer to resolve issues and brings continued problems to the attention of their manager.
Monitors patient accounts for secondary payer reimbursement.
Medicare payer:
Gets electronic remittance advice (R/A) ready for the Accounts Receivable Clerks. Distributes Medicare mail.
Reviews DRG worksheet for accuracy of reimbursement. Reviews all denied changes for appropriateness.
Reviews the Pending Billing List report and deletes non-covered services. Checks for overlapping claims through accounts receivable inquiry (ARI).
Reviews and processes recurring accounts according to procedure.
If responsible for professional billing, processes these bills according to procedure.
Reviews and follow up on the DDE system.
Medi-Cal payer:
Maintains full and complete knowledge of the regulations governing the Medi-Cal payer.
Reviews the Pending Billing List report and/or the Final Accounts and Cycle Billed report. Follow up is completed according to procedure.
Reviews and processes R/A's following procedure.
Reviews MEDTRIEVE data to identify problems in billing. Reviews statistical data with their Manager to maximize reimbursement
Reviews Medi-Cal TAR Dashboard weekly for any follow up on approved or denied TARs.
Self-pay accounts:
Responsible for the administration of the Computer Collection letter service interface (CCI) process.
Prepares and completes the bad debt write-off and assignment to the collection agency.
Acts as a liaison to the collection agency and works with patients regarding hospital accounts assigned.
Responsible to identify patient accounts that may qualify for charity care. Works with patients who inquire about charity program.
Monitors patient accounts pending the Medi-Cal disability process and/or TCMS program.
Responsible for the estate lien filing in the case of deceased patients to assure that the Kaweah Health receives payment on accounts.
Lead also responsible for:
May be responsible for educating individuals in the Patient Accounting Department on new processes and/or payment regulations.
May be assigned to develop training curriculum on new processes.
Provides department staff with information regarding updates or changes.
May serve as a Subject Matter Expert (SME) for systems issues and claim payment issues.
Identifies, investigates, and appropriately communicates account errors in order to prevent further errors.
Proactively and critically analyzes departmental processes and products, makes continuous improvements.
Keeps the Director of Patient Financial Services informed of any potential issues or areas of concern on an ongoing basis.
Pay Range
$23.37 -$35.05
If you want to use your talents alongside people who face each day with courage and purpose, in an environment that empowers you to do your absolute best, this is where you belong.</div>

Patient Account Specialist

Macrise Tech Solutions

Patient Billing &amp; Account Services SpecialistThe Patient Billing &amp; Account Services Specialist is responsible for managing patient financial communications, payment processing, account maintenance, and billing support activities. This role requires strong customer service skills, attention to detail, and the ability to effectively resolve billing inquiries while ensuring accurate account management and timely payment collection. The position supports overall revenue cycle performance by maintaining accurate financial records and providing exceptional patient assistance.Key ResponsibilitiesPatient Communication &amp; Account Support<ul><li>Conduct outbound outreach to patients regarding outstanding balances, payment reminders, account updates, and billing-related matters.</li><li>Respond to inbound patient inquiries concerning billing statements, account balances, payment arrangements, and general account questions.</li><li>Provide professional, courteous, and empathetic customer service while addressing patient concerns and offering accurate billing information.</li><li>Assist patients in understanding payment options, financial responsibilities, and available payment solutions.</li></ul>Billing &amp; Payment Processing<ul><li>Accurately post insurance and patient payments within the practice management and billing systems.</li><li>Process manual payments and receipts while ensuring all financial transactions are properly documented and reconciled.</li><li>Generate, distribute, and monitor electronic billing statements in a timely manner.</li><li>Establish, maintain, and monitor patient payment plans according to organizational policies and guidelines.</li><li>Process recurring and scheduled payment plan transactions while ensuring accurate posting and account reconciliation.</li></ul>Account Maintenance &amp; Reconciliation<ul><li>Review patient accounts to identify payment posting discrepancies, resolve errors, and perform necessary account adjustments.</li><li>Maintain accurate and current patient demographic, insurance, and financial information within the billing system.</li><li>Document all billing activities, account updates, patient communications, and payment transactions thoroughly and accurately.</li><li>Perform routine account audits to ensure data integrity and financial accuracy.</li></ul>Encounter Review &amp; Documentation Management<ul><li>Review patient encounters to verify accurate charge capture and alignment with services rendered.</li><li>Collaborate with clinical, administrative, and billing teams to resolve incomplete, missing, or inaccurate encounter documentation.</li><li>Maintain organized and up-to-date billing records within the practice management system.</li><li>Support compliance initiatives by ensuring proper documentation and record retention standards are maintained.</li></ul>Core Competencies<ul><li>Strong knowledge of medical billing, patient accounts, and revenue cycle processes.</li><li>Excellent communication, customer service, and conflict-resolution skills.</li><li>High attention to detail and accuracy in payment posting and account reconciliation.</li><li>Ability to manage multiple priorities while meeting deadlines.</li><li>Proficiency with electronic health records (EHR), practice management, and billing systems.</li></ul>Pay: Rs40,000.00 - Rs70,000.00 per monthAbility to commute/relocate:<ul><li>Wapda Town: Reliably commute or planning to relocate before starting work (Preferred)</li></ul>Application Question(s):<ul><li>Willing to work the night shift, Wapda Town, Lahore?</li></ul>Experience:<ul><li>Medical Billing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Preferred)</li></ul>Work Location: In person

Medical Billing & Collections Specialist

Novant Health

<div>What We Offer:

Novant Health is seeking a Pharmacy Reconciliation Specialist, to join our corporate pharmacy team, to deliver optimal medication management across all dimensions of care, every time. 
Schedule: Monday - Friday, 8am - 5pm. Primarily remote with possible onsite expectation. North or South Carolina residency highly preferred<div> 
The Pharmacy Reconciliation Specialist responsibilities will include includes reconciliation of pharmacy third party claims, investigating non-matched unpaid and underpaid claims, reconciliation of Novant Health interdepartmental pharmacy charges while maintaining organized and accurate pharmacy records.</div> 
Essential functions include:<ul><li>
Facilitate pharmacy financial vitality by using current technology to reconcile pharmacy accounts and third party transactions</li><li>
Problem solves pharmacy account discrepancies</li><li>
Review accuracy of pharmacy daily receipts</li><li>
Process vouchers as needed</li><li>
Continually work with pharmacy teams, vendors, third party plans, and departments within Novant Health to facilitate reconciliation</li><li>
Point of contact for patient account inquires</li><li>
Responsible for aged pharmacy accounts and timely patient communication</li><li>
Able to communicate clearly, both oral and written. Talks in a way the customer can understand</li><li>
Provides customer service with the goal of exceeding expectations in the areas of courtesy, commitment, communication, customer wait, privacy, and request</li><li>
Organize and maintain accurate pharmacy records</li><li>
Maintain skills and knowledge through participation in service-related learning opportunities</li><li>
Ensure compliance with North Carolina Board of Pharmacy, CMS, third party plans and Novant Health</li><li>
Demonstrates ability to successfully inform patient/team members of specific information including need for more information, signatures on forms, or other items required by third party payers</li><li>
Special duties or projects as directed</li></ul>
Patient centered pharmacy or healthcare customer service experience highly preferred
What We're Looking For:
<ul><li>Education: High School or GED, required. 4 Year/Bachelors Degree, preferred. Pharmacy Technician certification, preferred.</li><li>
Experience: One year customer service, required. Outpatient pharmacy and pharmacy third party experience preferred. 
</li><li>
Additional Skills Required:<ul><li>
Must have highly developed work ethic and the ability to convey information over the phone while being professional, empathic, and sympathetic, when necessary. Excellent communication skills and Excellent grammar. Must be detail oriented. Requires the ability to work independently. Must be able to function as part of a goal driven team. Must possess initiative. Must be experienced with Microsoft office i.e. Excel. Knowledge of operation of copy machine, fax machine.</li></ul></li></ul></div>

Pharmacy Reconciliation Specialist

Aveanna Healthcare

<div><div>Billing Specialist
Start Date: Tentative / Pay: $18-$19/HR
Schedule: Monday - Friday / 8am - 5pm MST
*All Candidates must be auhorized to work in the United States without sponsorship*
Position Overview
As a Billing Specialist, you&rsquo;ll play a vital role within our Reimbursement Team, ensuring accurate and timely collection of patient accounts while supporting the financial health of our organization. You will be responsible for managing aged accounts, resolving billing issues, and working closely with internal teams and payers to secure proper reimbursement.
We are looking for someone who can confidently manage accounts receivable, stay organized in a fast-paced environment, and communicate effectively with both internal teams and external payers. Whether you have experience in medical billing or are looking to grow within healthcare revenue cycle, this role offers the opportunity to build valuable expertise.
Our Mission: To revolutionize the way homecare is delivered, one patient at a time.
Why Join Us?<ul><li>
100% Remote</li><li>
Equipment Provided</li><li>
Fun, Inclusive Work Environment</li><li>
Full Benefits Package (Sick Time, Vacation, 401K, Dental, Vision, Life Insurance)</li><li>
2 Bonus Days Off (&ldquo;Fun Day&rdquo; and &ldquo;Inclusion Day&rdquo;)</li><li>
6 Paid Holidays</li><li>
Supportive Team with Role-Based Training to Aid in Your Success</li><li>
Internal Opportunities for Growth</li><li>
Interactive Clubs and Engagement Opportunities</li></ul>
What You'll Do:<ul><li>
Resolve delinquent accounts receivable across commercial, Medicare, Medicaid, and private payers</li><li>
Follow up on unpaid, underpaid, and denied claims to ensure maximum reimbursement</li><li>
Document collection activity and payer communications accurately in the EMR</li><li>
Submit adjustments and coordinate claim corrections or rebilling as needed</li><li>
Review payer correspondence and address patient or guarantor billing inquiries</li><li>
Meet departmental productivity, A/R aging, DSO, and cash collection goals</li><li>
Ensure compliance with payer requirements, SOX controls, and internal policies</li></ul>
The Right Fit Is:
<ul><li>Has Healthcare billing or accounts receivable experience</li><li>
Strongly knowledged with insurance billing and denial resolution</li><li>
Detail-oriented with a strong sense of urgency and ownership</li><li>
Able to prioritize work and meet deadlines in a remote environment</li></ul>
Remote Work Requirements:
<ul><li>Ability to maintain a quiet, dedicated workspace that is free of background noise and ongoing distractions</li><li>
Ability to participate in virtual meetings with a professional, camera-ready presence</li><li>
Ability to demonstrate strong time-management skills, as well as accountability and self-direction</li><li>
Must be able to operate off reliable, high-speed internet</li></ul>
Position Qualifications:
<ul><li>2+ years of healthcare billing or accounts receivable experience</li><li>
Knowledge of Medicare, Medicaid, and commercial payer requirements</li><li>
Experience with denials management and AR follow-up</li><li>
Proficiency in EMR systems and Microsoft Office</li><li>
Must be fluent in English with the ability to read, write, and verbally communicate in English</li></ul>
Equal Employment Opportunity and Affirmative Action: Aveanna provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Aveanna complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.</div>
As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.
Notice for Job Applicants Residing in California
Notice for Job Applicants Residing in Florida</div>

Billing Specialist (REMOTE)

Riverview Health

<div>
 
 Job Summary
 
 
 
 The Authorization Specialist is responsible for ensuring that payers are prepared to reimburse Riverview Health for scheduled services in accordance with the payer-provider contract. The Specialist contacts payers to request service authorization and may collect clinical, financial and/or demographic information from clinics, hospital departments and/or patients as needed.
 
 
 
 Job Responsibilities
 
 
 
 <ul>
 <li>
 Verifies patients&rsquo; insurance and benefits information
 </li>
 <li>
 Obtains prior authorizations from third-party payers in accordance with payer requirements. Identifies patients who will need to receive Medicare Advance Beneficiary Notices of Noncoverage (ABNs).
 </li>
 <li>
 Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
 </li>
 <li>
 Works with other departments to gather the clinical information required by the payer to authorize services. Maintains accurate records of authorizations within EMR.
 </li>
 <li>
 Develops price estimates for patient out-of-pocket responsibility.
 </li>
 <li>
 Refers accounts to financial counseling as needed if authorization is not obtained. Works with business office staff to support appeal efforts for authorization-related denials.
 </li>
 <li>
 Reviews surgery schedules to ensure Medicare patients with IP-only procedures have the appropriate authorization and order.
 </li>
 <li>
 Complies with HIPAA regulations, as well as Riverview Health policies and procedures regarding patient privacy and confidentiality.
 </li>
 <li>
 Maintains professional tone at all times when communicating with patients and payer representatives.
 </li>
 <li>
 Coordinates re-education to practices or hospital departments when orders are incorrect or not supported by the given diagnosis.
 </li>
 <li>
 Performs other duties as requested.
 
 
 </li>
 </ul>
 
 Education Requirements
 
 
 
 <ul>
 <li>
 Minimum: Associate degree in healthcare or business administration and/or related coursework, or comparable experience
 </li>
 <li>
 Preferred: Experience in Epic
 
 
 </li>
 </ul>
 
 Experience Requirements
 
 
 
 <ul>
 <li>
 Minimum: Two years of experience in a healthcare setting performing related tasks
 </li>
 <li>
 Preferred: Five years of experience in a healthcare setting performing related tasks
 
 
 </li>
 </ul>
 
 License/Certification Requirements
 
 
 
 <ul>
 <li>
 None
 
 
 </li>
 </ul>
 Education
 
 
 
 Required
 
 
 
 <ul>
 <li>
 Associates or better in Other
 
 
 </li>
 </ul>
 Equal Opportunity Employer
 
 
 This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
</div>

Authorization Specialist

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