Patient Billing Specialist II

FHLB Des Moines; Seattle, Northern (WA, KY); Hybrid; USD 32,000 - 46,000; Full time

Job summary

UW Medicine’s Patient Financial Services is seeking a Patient Account Representative 2 for a 40-hour day shift. You will edit and submit billing forms, analyze unresolved claims, perform claim follow-up, and resolve payer denials to keep patient accounts current.

Responsibilities include reviewing accounts, processing AR adjustments, researching credits, verifying eligibility, updating demographics, and communicating with staff and payers to ensure accurate reimbursements.

Qualifications

• High School graduation or equivalent AND two years of experience in patient accounting, customer service, or a related office environment.

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, 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

Education

High School diploma or equivalent

Job description

UW Medicine’s Patient Financial Services is seeking a Patient Account Representative 2 for a 40-hour day shift. You will edit and submit billing forms, analyze unresolved claims, perform claim follow-up, and resolve payer denials to keep patient accounts current.

Responsibilities include reviewing accounts, processing AR adjustments, researching credits, verifying eligibility, updating demographics, and communicating with staff and payers to ensure accurate reimbursements.