Patient Billing & A/R Specialist II

University of Washington Medical Center; Oregon; Hybrid; USD 32,000 - 46,000; Full time

Benefits offered by this job

Benefits information

Job summary

UW Medicine’s Patient Financial Services is seeking a Patient Account Representative 2 to join a busy team in a day shift. You will edit, prepare and submit standard billing forms, perform follow-up on insurance accounts, review denials, and resolve payment discrepancies.

You will update demographics, verify eligibility, communicate with payers, and maintain tracking tools for efficiency and accuracy. A two-year related background and a strong understanding of payer requirements are essential.

Qualifications

• High School graduation or equivalent AND two years of experience in patient accounting, customer service, or a related office environment.
• Equivalent education and/or experience may substitute for minimum qualifications except when there are legal requirements, such as a license, certification, and/or registration.
• Knowledge of UB, CMS 1500, ADA and other utilized billing forms and payer requirements.

Responsibilities

• EDIT, prepare, and submit UB-04, CMS-1500, ADA and other applicable billing forms and electronic claims in accordance with regulatory requirements.
• Analyze and take appropriate action on unresolved insurance accounts, including denied, rejected, unpaid, underpaid, suspended, or otherwise unresolved claims.
• Perform insurance claim and account follow-up by researching claim status, payer processing requirements, eligibility, benefits, authorizations, medical necessity requirements, payment discrepancies.
• Review and analyze payer denials and claim rejections to determine the appropriate corrective action, including claim correction, rebilling, reconsideration, appeal, adjustment, or other payer follow-up necessary to resolve the account.
• Review the status of the entire patient account and exercise independent judgment to determine the appropriate course of action for resolution, considering claim history, payer responses, payments, adjustments, outstanding balances.
• Prepare and/or process Accounts Receivable adjustments in accordance with departmental policies, payer requirements, contractual terms, and established adjustment guidelines.
• Analyze insurance credit-balance accounts to determine the cause of the credit balance and take appropriate action to resolve payer overpayments, duplicate payments, payment posting discrepancies.
• Utilize available systems, payer portals, internal resources, and other reference materials to obtain and verify insurance eligibility, benefits, coverage, authorization, claim status, payment
• Update patient demographic, insurance, and payer information in applicable systems to support accurate claim submission, payer processing, reimbursement, and account resolution
• Communicate effectively with Medical Center staff and third-party payers as required to obtain, verify, and resolve billing, claim, eligibility, authorization, payment, reimbursement information
• Maintain spreadsheets, reports, and other tracking tools to support account follow-up, workload management, payer activity, reimbursement analysis, and departmental reporting; utilize Microsoft Excel, Word, and other applicable software to prepare correspondence and documentation

Skills

Patient accounting

Customer service

Office environment

Education

High School diploma or equivalent

Job description

UW Medicine’s Patient Financial Services is seeking a Patient Account Representative 2 to join a busy team in a day shift. You will edit, prepare and submit standard billing forms, perform follow-up on insurance accounts, review denials, and resolve payment discrepancies.

You will update demographics, verify eligibility, communicate with payers, and maintain tracking tools for efficiency and accuracy. A two-year related background and a strong understanding of payer requirements are essential.