Patient Account Specialist

The Patient Account Specialist supports the professional billing and revenue cycle activities of the Facial Plastic Surgery and Audiology Divisions within the Department of Otolaryngology. This position is responsible for ensuring timely and accurate charge entry, claim follow-up, denial resolution, insurance authorization, patient account support, and communication with departmental and medical group revenue cycle personnel.

The Patient Account Specialist works extensively within the Epic electronic medical record and billing system and serves as a resource for patients, providers, clinical staff, departmental leadership, and medical group representatives regarding billing and account-related matters.

General Billing and Revenue Cycle Responsibilities

• Review patient encounters and supporting documentation to ensure billing information is complete, accurate, and ready for claim submission.
• Enter, review, and reconcile professional charges within Epic in accordance with departmental procedures, payer requirements, and established billing timelines.
• Identify missing, incomplete, or inaccurate charges and communicate with providers and clinical staff to obtain necessary clarification or documentation.
• Monitor charge work queues, claim edit work queues, account follow-up work queues, and other assigned Epic revenue cycle reports.
• Review rejected and denied claims to determine the cause of the denial and complete the appropriate corrective action.
• Perform denial management activities, including claim correction, resubmission, reconsideration requests, appeal preparation, documentation review, and payer follow-up.
• Track recurring denial trends and communicate identified issues to departmental leadership, medical group revenue cycle personnel, providers, and clinical staff.
• Follow up on unpaid, underpaid, or incorrectly processed claims with insurance carriers and other third-party payers.
• Review accounts for appropriate insurance coverage, patient responsibility, contractual adjustments, and payment application.
• Assist with account reconciliation and resolution of outstanding balances.
• Respond to patient questions regarding charges, insurance processing, account balances, payment expectations, and billing statements in a professional and timely manner.
• Research patient inquiries within Epic and coordinate with the medical group, insurance carriers, or departmental staff as needed to resolve concerns.
• Document all account activity, payer communications, patient discussions, and follow-up actions accurately within Epic.
• Maintain confidentiality of patient, financial, and clinical information in accordance with HIPAA and organizational policies.
• Support compliance with applicable federal and state regulations, payer policies, coding requirements, and organizational billing standards.
• Assist departmental leadership with revenue cycle reports, account research, billing audits, and special projects.
• Participate in meetings with divisional leadership, providers, clinical staff, and medical group revenue cycle representatives as needed.
• Maintain current knowledge of payer requirements, Epic workflows, departmental billing procedures, and relevant revenue cycle policies.
• Perform other related duties as assigned.

Audiology and Hearing Aid Responsibilities

• Support billing activities for audiology diagnostic services, hearing aid evaluations, hearing aid devices, hearing aid fittings, repairs, supplies, accessories, and related services.
• Verify patient insurance benefits and coverage requirements for hearing aid services and devices.
• Obtain prior authorizations, pre-certifications, or other payer approvals required for hearing aid devices and related services.
• Submit required clinical documentation,…