Hospital Patient Billing & Claims Specialist

Boston Children’s Hospital; Boston; On-site; PHP 1,791,000 - 2,731,000; Full time

Job summary

Boston Children’s Hospital is seeking a Patient Accounts Representative for a full-time position. The role involves managing patient accounts, verifying insurance information, submitting accurate claims, resolving billing issues, and maintaining timely communication with patients, families, payers, and internal departments.

Ideal candidates will have hospital-based billing experience, knowledge of CPT codes and payer processes, and the ability to collaborate with clinical teams to resolve

Qualifications

• High school diploma or GED required.
• Experience in medical billing preferred.
• Ability to analyze and interpret routine account and billing information.
• Strong attention to detail and organization.
• Excellent written and verbal communication.

Responsibilities

• Verify and update patient demographic, insurance, referral, and authorization information to ensure accurate account processing.
• Confirm insurance eligibility using payer websites, available technology, and communication with third-party payers.
• Prepare and submit accurate insurance claims within required timeframes.
• Review claims for accuracy, resolve billing errors, and address claim processing issues with payers.
• Work payer scrubber and denial reports to identify and resolve outstanding insurance claims.
• Research and prepare payer appeals and provide necessary documentation to support claim payment.
• Maintain clear and accurate account notes documenting all actions taken.
• Collaborate with clinical departments, physician offices, referral/authorization teams, and other internal partners to resolve account issues.
• Monitor trends related to denials, claim errors, and payer issues and elevate concerns as appropriate.
• Maintain a working knowledge of third-party payer contracts and hospital billing processes.
• Participate in process improvement initiatives and departmental projects.

Skills

Detail oriented

Communication

Customer service

Team collaboration

Education

High school diploma or GED

Job description

Boston Children’s Hospital is seeking a Patient Accounts Representative for a full-time position. The role involves managing patient accounts, verifying insurance information, submitting accurate claims, resolving billing issues, and maintaining timely communication with patients, families, payers, and internal departments.

Ideal candidates will have hospital-based billing experience, knowledge of CPT codes and payer processes, and the ability to collaborate with clinical teams to resolve