Billing Specialist - Patient Account Representative

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• 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.

Qualifications

• High school diploma or equivalent required; associate degree or billing certification (e.g., CPB, CMRS, CBCS) preferred.
• 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.

Environmental Job Requirements and Working Conditions

• Scheduling options: 7:30 AM – 4:00 PM or 8:00 AM – 4:30 PM with a 30-minute lunch between 12:00–1:00 PM.
• The total compensation range for this role is $19–$22/hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.