Patient Accounts Resolution Specialist -- Patient Accounts -- General Hospital

Charleston Area Medical Center; North Charleston (WV); On-site; USD 25,000 - 30,000; Full time

Job summary

Charleston Area Medical Center General Hospital seeks a Patient Accounts Resolution Specialist to review unpaid/underpaid claims and ensure accurate, timely payment per policies, payer contracts, and regulations. You will follow up on denials, coordinate with coding and UR to resolve issues, and document actions in the encounter timeline.

Responsibilities include communicating with payers and physician offices, rebilling to prevent denials, and maintaining updated records for ongoing balances.

Qualifications

• High School Diploma or GED required.
• 1–2 years Collections or customer service experience; medical terminology background preferred.
• 5–7 years related experience preferred.

Responsibilities

• Review unpaid/underpaid claims to ensure accurate, timely payment per policies and contracts.
• Follow up on unpaid claims to ensure complete resolution and thorough documentation.
• Collaborate with coding to resolve denial issues.
• Coordinate with Utilization Review to resolve authorization denials and appeals.
• Use payer portals and DDE systems to obtain claim information for resolution.
• Contact payers by phone to resolve claim issues and obtain information.

Skills

Healthcare billing

collection knowledge

payer EOB interpretation

claim issue resolution

customer service

communication skills

computer skills

Education

High School Diploma or GED

Tools

Cerner

Microsoft Excel

Microsoft Word

Job description

Patient Accounts Resolution Specialist -- Patient Accounts -- General Hospital (Job ID: 81611)

Review unpaid and underpaid claims to ensure that claims are paid accurately and timely according to company policies, payer contracts, and governmental regulations. Perform follow up on unpaid or underpaid claims to ensure that claims are completely resolved accurately and timely and efforts are thoroughly documented.

Responsibilities

• Review assigned work items daily to resolve “at risk, past due, and technical denial” claim issues
• Work with coding to resolve coding related denials
• Work with Utilization Review to resolve authorization related denials and appeals
• Use various payer web portals and DDE systems to obtain claim information that will help in resolution
• Contact payers by phone to resolve claim issues
• Contact Physician offices to obtain necessary information needed to resolve claims
• Manually and accurately resolve claims in Suspense (Medicare only)
• Ensure that medical records and itemized statement are submitted and received when requested by payers (work with contracted agencies as applicable)
• Follow proper workflow assigned by management
• Ensure accurate rebilling of claims to avoid denials
• Communicate billing errors that can be prevented to Department Manager, Supervisor, or Team Lead
• Communicate identified system related issue to Department Manager, Supervisor, or Team Lead
• Accurately, Professionally, and thoroughly document necessary information necessary to resolve outstanding balances in encounter timeline
• Ensure that result driven follow up is be accomplished and documented.
• Other duties as assigned
• Skills: Healthcare billing and collection knowledge
• Ability to interpret a payer explanation of benefit (EOB)
• Ability to identify and resolve claim issues
• Excellent communication and customers service skills
• Computer and keyboarding skills
• Knowledge of Microsoft software applications (Excel and Word) a plus
• Cerner knowledge a plus

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact)The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department’s identified patient ages. Specifically the employee must be able to demonstrate competency in:

• ability to obtain and interpret information in terms of patient needs;
• knowledge of growth and development;
• understanding of the range of treatment needed by the patients.

Competency StatementMust demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist.

Common Duties and Responsibilities (Essential duties common to all positions)

• Maintain and document all applicable required education.
• Demonstrate positive customer service and co-worker relations.
• Comply with the company's attendance policy.
• Participate in the continuous, quality improvement activities of the department and institution.
• Perform work in a cost effective manner.
• Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations.
• Perform work in alignment with the overall mission and strategic plan of the organization.
• Follow organizational and departmental policies and procedures, as applicable.
• Perform related duties as assigned.

Education

• High School Diploma or GED (Required) Experience: 1-2 years collections, customer service, or other comparable experience. Medical Terminology background and 5-7 years related experience preferred.

Work Schedule

Days

Status

Full Time Regular 1.0

Location

General Hospital

Location of Job

US:WV:Charleston

Category

Administrative/Clerical

Employment Type

Employee

Salary

Negotiable

Post Date

10/29/2026

Talent Acquisition Specialist

Lisa J. Craft [e-mail]