Sr. Patient Account Specialist - Insurance

Sr. Patient Account Specialist - Insurance, Emerus Holdings, Inc.

This is a hybrid position with remote work 90% of the time and requires an in‑person commute to the office in The Woodlands, TX once a month.

We are Emerus, the leader in small‑format hospitals. We partner with respected and like‑minded health systems who share our mission to provide the care patients need, in the neighborhoods they live, by teams they trust. Our growing number of amazing partners includes Allegheny Health Network, Ascension, Baptist Health System, Baylor Scott & White Health, Christiana Care, Dignity Health St. Rose Dominican, The Hospitals of Providence, INTEGRIS Health, Multi Care and Well Span.

Our innovative hospitals are fully accredited and provide highly individualized care. Emerus’ commitment to patient care extends far beyond the confines of societal norms. We believe that every individual who walks through our doors deserves compassionate, comprehensive care, regardless of their background, identity, or circumstances. We are committed to fostering a work environment focused on teamwork that celebrates diversity, promotes equity and ensures equal access to information, development and opportunity for all of our Healthcare Pros.

The purpose of this position is to assist the Patient Account Supervisor in managing the company’s outstanding receivables through routine communication with all payers (e.g., commercial insurance, Medicare, private pay patients) to ensure that expected reimbursement for patient care is processed timely and paid accurately. This position works alongside staff and provides direction to less experienced staff in conjunction with the Patient Account Supervisor.

• Assist in assigning staff workloads and shift priorities as necessary.
• Follow up on submitted claims and complete action as appropriate to ensure timely receipt and appropriate reimbursement.
• Routinely communicate with payers regarding delinquent or denied claims, addressing issues and clearing barriers to payment.
• Manage claim details and verify accurate reimbursement to initiate account adjustments and/or appeals on payment disputes.
• File appeals for denied claims and follow up as necessary through appeal resolution.
• Maintain outstanding patient balances to ensure accurate reporting of the company’s accounts receivable.
• Utilize online/telephonic resources to verify benefits and ensure claims are processed according to the appropriate benefit levels.
• Review refund requests for accuracy and submit as necessary.
• Review adjustment requests for accuracy and submit as necessary.
• Develop and train workflow processes for staff and, as deemed necessary, for payer behavior responses.
• Work on special projects and provide ad‑hoc review of claims as assigned by Supervisor/Director/CFO.
• Work closely with CBO intra‑departments to ensure resolution of pending claim activities.
• Meet position’s goals and objectives related to accuracy and productivity (e.g., days in AR, cash collections).
• Attend staff meetings or other company‑sponsored or mandated meetings as required.
• Perform additional duties as assigned.

• High School Diploma or GED, required.
• 3+ years of relevant experience in a provider inpatient or outpatient setting, required.
• Advanced knowledge of claims processing, appeals, medical terminology, accounts receivable, claim forms, claims billing, insurance verification, adjustments and refunds, claims status, and reimbursement, required.
• 2+ years of previous Team Leader/Supervisory experience or equivalent, required.
• Advanced knowledge of all payer insurance groups, including Medicare, Medicaid and government managed care, required.
• Previous coaching and/or training experience and the ability to create training manuals and tools, preferred.
• Experience with medical records or patient accounting systems, required.
• Knowledge of state and Federal payment laws to ensure prompt and accurate reimbursement, required.
• Advanced knowledge of healthcare “explanation of benefits” (EOB’s), required.
• Experience with Microsoft Office products (Outlook, Excel, Word), required.
• Effective and professional written and oral communication skills, required.
• Position requires fluency in English; written and oral communication, required.

Mid‑Senior level

Full‑time

Health Care Provider

Hospitals and Health Care