Sr. Patient Account Specialist - Insurance Job Listing at Emerus Holdings Inc. in The Woodlands, TX (Job ID 2025-21074)

Description

The purpose of this position is to assist the Patient Account Supervisor in managing the company's outstanding receivables, through routine communication with all payers (e.g. commercial insurance, Medicare, private pay patients, etc.) to ensure that expected reimbursement for patient care is processed timely and paid accurately.  This position is expected to work alongside staff as well as provide serves as This position is expected to work alongside staff as well as provide direction to less experienced staff in conjunction with the Patient Account Supervisor.

• High School Diploma or GED, required
• 3+ years relevant experience in a provider inpatient or outpatient setting, required
• Requires advanced knowledge of claims processing, appeals, medical terminology, accounts receivable, claim forms, claims billing, insurance verification, adjustments and refunds, claims status, and reimbursement
• 2+ years previous Team Leader/Supervisory experience or equivalent , required
• Advanced knowledge of all payer insurance groups, including a Medicare, Medicaid and government managed care experience, is required
• Previous coaching and or training experience and the ability to create training manuals and training tools and materials, preferred
• Experience with medical records or patient accounting systems, required
• Knowledge and understanding of state and Federal payment laws to ensure prompt and accurate reimbursement, required
• Advanced knowledge and understanding of healthcare ‘explanation of benefits' (EOB's), required
• Experience with Microsoft Office products (Outlook, Excel, Word), required
• Effective and professional written and oral communication skills

• Position requires fluency in English; written and oral communication

• Assists in assigning staff workloads and shifts priorities as necessary
• Follow up on submitted claims (i.e., claim received, pending, processing, paid, etc.) and complete action as appropriate to ensure timely receipt and appropriate reimbursement
• Routinely communicate with payers regarding delinquent or denied claims, addressing issues and clearing barriers to payment
• Responsible for managing claim details and verifying accurate reimbursement, so as to initiate account adjustments and/or appeals on payment disputes 
• File appeals for denied claims and follow-up as necessary through appeal resolution
• Manage and maintain outstanding patient balances to ensure accurate reporting of company's accounts receivable
• Utilize on-line/telephonic resources to verify benefits and ensure claims are processed according to the appropriate benefit levels
• Assists in the review of refund request for accuracy and submits as necessary
• Assists in the review of adjustment requests for accuracy and submits as necessary
• Assists in the development and training of workflow process for staff and as deemed necessary for payer behavior responses
• Works special projects and provides ad hoc review of claims as assigned by Supervisor/Director/CFO
• Works closely with CBO intra departments to ensure resolution of pending claim activities.

• Meet position's goals and objectives related to accuracy and productivity (e.g. days in AR, cash collections, etc.)
• Attend staff meetings or other company sponsored or mandated meetings as required
• Perform additional duties as assigned