Patient Account Specialist

We are seeking an experienced Patient Account Specialist Sr. with a strong background in medical insurance collections and denial resolution. This role is responsible for managing accounts receivable, resolving denied or underpaid claims, and ensuring accurate and timely reimbursement from insurance payers.

This is a fully onsite position supporting a high-volume healthcare collections environment. Candidates must be comfortable working directly with payers, patients, and third-party vendors while maintaining compliance with all regulatory guidelines.

Key Responsibilities

• Manage and collect outstanding balances from commercial and government insurance payers
• Investigate and resolve denied and underpaid claims within payer guidelines
• Perform detailed follow-up and account resolution activities for assigned AR inventory
• Utilize knowledge of payer processes, appeals, and reimbursement methodologies
• Interpret EOBs (Explanation of Benefits) and ensure proper billing and filing compliance
• Work within payer portals and systems to track and resolve claims
• Identify trends impacting reimbursement and escalate issues as needed
• Communicate effectively with patients, clients, and external vendors
• Maintain compliance with all state, federal, and client-specific regulations

Qualifications

• Minimum 2+ years of experience in medical collections or healthcare revenue cycle
• Proven experience with insurance claims denials and appeals
• Strong understanding of:
• AR follow-up (active AR & bad debt)
• Insurance billing and reimbursement processes
• Government and commercial payer guidelines
• Familiarity with EOBs, billing forms, and payer portals
• Strong communication and problem-solving skills
• Ability to work in a fast-paced, high-volume environment