Patient Account Representative / Billing Specialist

Position Summary

The Patient Account Representative / Billing Specialist is responsible for supporting the revenue cycle and patient experience within a busy nephrology practice. This position serves as a primary point of contact for patients regarding insurance coverage, prior authorizations, copayments, billing questions, and account balances. The role requires strong customer service skills, attention to detail, and the ability to work collaboratively with clinical and administrative staff to ensure timely reimbursement and excellent patient care.

Essential Duties and Responsibilities

Insurance Verification and Prior Authorizations

• Verify patient insurance eligibility and benefits.

• Obtain and process prior authorizations for office visits.

• Monitor authorization status and ensure approvals are obtained before services are rendered.

• Communicate authorization requirements and updates to patients, providers, and staff.

Patient Financial Services

• Collect copayments, deductibles, coinsurance, and outstanding balances at the time of service and through follow-up outreach.

• Educate patients regarding insurance benefits, financial responsibility, payment options, and billing inquiries.

• Process patient payments accurately and maintain appropriate documentation.

Claims Management and Accounts Receivable

• Review, submit, and follow up on insurance claims to ensure timely reimbursement.

• Investigate and resolve claim denials, rejections, underpayments, and payment discrepancies.

• Work payer claim edits and appeals according to established guidelines.

• Maintain accurate account documentation within the practice management system.

Statements and Collections

• Generate and review patient statements for accuracy.

• Conduct collection activities for outstanding patient balances in accordance with practice policies and applicable regulations.

• Establish payment arrangements when appropriate.

• Maintain professionalism and sensitivity when discussing financial matters with patients.

Patient Communication and Customer Service

• Answer incoming telephone calls promptly and professionally.

• Respond to patient questions regarding appointments, insurance, billing, balances, and account status.

• Provide exceptional customer service during daily patient interactions, both in person and by phone.

• Route calls and messages to appropriate staff members as needed.

Administrative Responsibilities

• Maintain patient confidentiality and comply with all HIPAA regulations.

• Document all patient and payer communications accurately and timely.

• Assist with other billing department duties and special projects as assigned.

• Support departmental goals related to collections, denial management, and patient satisfaction.

Qualifications

Education and Experience

• High school diploma or equivalent required.

• Minimum of two years of experience in medical billing, patient accounts, insurance verification, or revenue cycle management preferred.

• Experience with nephrology, specialty medical practices, or chronic disease management preferred.

• Knowledge of insurance plans, including Medicare, Medicaid, commercial insurance, and Medicare Advantage plans preferred.

Knowledge, Skills, and Abilities

• Understanding of medical terminology, insurance guidelines, and prior authorization processes.

• Knowledge of medical billing, claims processing, and collections procedures.

• Strong communication, customer service, and problem-solving skills.

• Ability to manage multiple priorities in a fast-paced environment.

• Proficiency with electronic health records (EHR), practice management systems, and Microsoft Office applications.

• Strong attention to detail and organizational skills.

Physical Requirements

• Ability to sit for extended periods while using a computer and telephone.

• Ability to communicate effectively in person and by telephone.

• Ability to occasionally lift up to 20 pounds.

Work Environment

This position operates in a professional medical office environment and requires frequent interaction with patients, providers, insurance companies, and other healthcare team members.