[Hiring] Patient Account Specialist @GoHealth Urgent Care

Role Description

The Patient Account Specialist is responsible for taking all inbound phone calls, researching customer issues, collecting customer information, collecting payments from customers, and responding to all customer inquiries via fax/email/calls.

Qualifications

• High School Diploma or GED
• 3+ years of healthcare, billing, or service experience
• 3 years Medical Billing experience
• CPAR – Certified Patient Account Representative
• Associate’s degree in business administration or related field
• Medical insurance billing and claims processing
• Epic or eClinicalWorks experience
• Bilingual (Spanish)
• Understanding of basic medical terminology and common healthcare documentation
• Highly experienced in Microsoft Excel and Word for data entry, reporting, and documentation
• Strong working knowledge of medical billing codes such as CPT and ICD coding for accurate billing and claims processing
• Exceptional phone and communication skills with the ability to interact effectively across departments and with customers
• Ability to organize and prioritize tasks efficiently in a fast-paced environment
• Proficient in navigating computer systems and performing mathematical calculations related to customer accounts and billing
• Ability to maintain strict customer confidentiality in compliance with HIPAA and company policies
• Demonstrated ability to follow through with customer inquiries and resolve issues with professionalism and sound judgment
• Demonstrate flexibility and open-mindedness when approaching problem-solving and adapting to changing workflows or priorities
• Ability to calculate deductibles and co-insurance accurately
• Ability to read and interpret Explanation of Benefits (EOBs)
• Skilled in performing collection activities related to follow-up and account resolution
• Ability to identify under and overpayments from payors and take appropriate action
• Experience with third-party payor portals for eligibility verification, claim status, and account resolution

Requirements

• Accurately update and maintain customer demographic and insurance information
• Update and document patient account clearly and thoroughly to include information received and given during patient interaction
• Conduct thorough review of patient accounts to verify that required documentation is properly scanned and recorded
• Deliver high-level customer service to internal customers, payors, and urgent care centers
• Provide exceptional service to customers, ensuring a positive and professional experience
• Manage each customer inquiry through resolution, collaborating with internal teams as needed
• Address service-related issues professionally when interacting with customers, guests, physicians, and team members
• Communicate clearly with customers regarding medical and financial matters via phone, email, and other communication channels
• Serve as an effective extension of Company urgent care centers, supporting their mission and values
• Maintain composure and focus while managing multiple tasks and customer interactions in a high-pressure environment
• Actively listen to patients to identify financial needs and assist with financial assistance applications when appropriate
• Minimize patient escalations through one-call resolution
• Responsible for collecting unpaid customer balances and assisting with credit card payments
• Provides effective review of accounts leading to patient collection of outstanding balances
• Documents and updates patient accounts information for all payment and contested balances
• Performs research and analysis of account issues to timely and accurately resolve accounts
• Ability to review an account and offer prompt pay discounts to increase collections
• Accurately and timely submit for patient adjustments to satisfy balances if applicable
• Accurately calculate customer deductibles and co-insurance amounts based on insurance plan details and service charges
• Review and interpret Explanation of Benefits (EOBs) from insurance carriers to ensure appropriate account handling and customer communication
• Reviews patient claims to articulate the reason for outstanding balances
• Ability to review claims and take appropriate action, including identifying why a claim was denied and resubmitting for processing
• Validating commercial insurance, including patient eligibility, referrals, and authorizations as necessary to secure carrier payment
• Maintain consistent daily communication with Team and Section leaders
• Share relevant information with team members to support collaboration and continuity of care
• Appropriately document any barriers in issue resolution and escalate as needed for review
• Assist colleagues with tasks and responsibilities when time permits
• Appropriately identify and assign tasks and responsibilities to internal departments when additional action is required

Benefits

• Tasks may be conducted within a climate-controlled office setting
• The role may require the ability to lift, carry, push, or pull materials, supplies, and equipment (up to 15 lbs.)
• Travel may be required, including travel between facility locations, remote facilities, and out-of-town destinations as needed (0-10%)
• May require the use of safety equipment for infection prevention

Company Description

The Company and its affiliates, joint venture partners, and entities under common management are Equal Opportunity Employers. They do not discriminate based on race, color, religion, national origin, age, sex, disability, veteran status, sexual orientation, gender identity, or any other protected status under federal, state, or local law.