Hybrid Patient Billing & Denials Specialist

Charles River Community Health; Boston (MA); Hybrid; USD 30,000 - 40,000; Full time

Benefits offered by this job

Medical, Vision & Dental Insurance

Disability & Life Insurance

Generous Paid Time Off

Flexible Spending Account

Job summary

Charles River Community Health seeks a Patient Accounts Representative to manage charge review, payment posting, denials, and patient billing using Epic Revenue Cycle. You will reconcile accounts, monitor AR, and resolve issues across departments to ensure accurate and timely billing.

The role requires 3+ years of medical billing experience, proficiency with Word/Excel, and strong collaboration skills to support equitable patient care in our community.

Qualifications

• Three years of medical billing experience, preferably in a multi-service FQHC environment.
• Understanding of the third party billing cycle and payer reimbursement rules, methodologies, and adjudication systems.
• Experience with denial management, payment posting, charge reconciliation, reimbursement review, accounts receivable follow-up, and overpayment processing preferred.
• Demonstrated ability to communicate, collaborate, and problem solve across multiple functional areas and departments.
• Proficient with Word and Excel at least at an intermediate level.

Responsibilities

• Process and reconcile 835 files, reimbursement payments, EOBs, cash receipts, and other payer transactions, ensuring accurate payment posting, claim reconciliation, rejection resolution, and rebilling as necessary.
• Monitor insurance accounts receivable, investigate outstanding claims, and follow up on denials through corrective actions, appeals, rebilling, and other resolution activities.
• Work assigned claims, charge review, denial, and overpayment accounts through Epic Revenue Cycle workqueues.
• Review and resolve claim edits, billing exceptions, reimbursement discrepancies, and denial accounts routed through Epic workqueues.
• Process assigned overpayment, refund, recoupment, and payer adjustment accounts according to organizational and payer guidelines.
• Follow established workflows and productivity standards for the timely resolution of Epic workqueue assignments.
• Understand account adjustments, corrections and write-offs to bad debt, and free care and input same into system.
• Understand the setup of the accounts receivable system in such areas as insurance carriers, claim forms, reimbursement methodologies, payer requirements, and service codes.
• Review and track encounter forms produced from the health center’s electronic record system.
• Review, validate, and post charges within Epic including service codes, fees, insurance billing information, patient copayments, and supporting documentation required for the generation of claims to third-party payers
• Work collaboratively with providers to correct incomplete and/or incorrect service and/or diagnosis codes and ensure electronic record documentation is complete for billing purposes.
• Prepare and process patient bills and third party claims.
• Communicate billing discrepancies and information requests to appropriate parties and respond to patient and staff inquiries regarding billing, payment posting, claims processing, denials, reimbursements, and overpayments.
• Maintain patient confidentiality when discussing information regarding patient bills.
• Work collaboratively with other Health Center staff in meeting JCAHO accreditation and other regulatory and/or funding requirements.
• Perform other departmental support duties such as telephone answering and filing.
• Perform other duties as assigned by Patient Accounts Manager or designee.

Skills

Medical billing experience

Denial management

Payment posting

Communication

Word proficiency

Excel proficiency

Independent work

Education

High school diploma or equivalent

Tools

Epic Revenue Cycle

Practice management software

Job description

Charles River Community Health seeks a Patient Accounts Representative to manage charge review, payment posting, denials, and patient billing using Epic Revenue Cycle. You will reconcile accounts, monitor AR, and resolve issues across departments to ensure accurate and timely billing.

The role requires 3+ years of medical billing experience, proficiency with Word/Excel, and strong collaboration skills to support equitable patient care in our community.