Patient Billing & Account Resolution Specialist

University of Washington; Seattle (WA); On-site; USD 32,000 - 45,000; Full time

Job summary

UW Medicine is seeking a Patient Account Representative 2 to join its Financial Services team in Seattle. The role focuses on processing UB-04, CMS-1500, and related claims, performing comprehensive follow-up on insurance accounts, and resolving denials and underpayments to optimize patient accounts.

You will work with payer portals, check eligibility, and update patient data while coordinating with medical center staff to ensure accurate reimbursement.

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.

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
• 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
• 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, and 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

UB-04 knowledge

CMS-1500 knowledge

Insurance billing

Account follow-up

Excel familiarity

Tools

Epic Hospital Billing

SBO billing systems

Payer portals

Job description

UW Medicine is seeking a Patient Account Representative 2 to join its Financial Services team in Seattle. The role focuses on processing UB-04, CMS-1500, and related claims, performing comprehensive follow-up on insurance accounts, and resolving denials and underpayments to optimize patient accounts.

You will work with payer portals, check eligibility, and update patient data while coordinating with medical center staff to ensure accurate reimbursement.