Patient Account Specialist (PST/MST only)

You’re more valuable than ever – And that’s just how we’ll make you feel.

Summary

The Patient Account Specialist is responsible for taking all inbound phone calls, researching

customer issues, collecting customer information, collecting payments from customers, responding to all customer inquiries via fax/email/calls.

Qualifications

Education Required: 

• High School Diploma or GED

Work Experience Required: 

• 3+ years of healthcare, billing, or service experience

Preferred Qualifications, Education, Licenses, Certifications, Experience, etc.:

• 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)

Knowledge, Skills, and Abilities

• This role is patient facing and involves interaction and collaboration with other departments and requires excellent judgment and interpersonal skills.
• Strong interpersonal skills including sound judgement while working with cross functional departments.
• 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 Current Procedural Terminology
• (CPT) and International Classification of Diseases (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.

Essential Duties and Responsibilities

Administrative and Data Accuracy

• 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, ensuring no unnecessary or duplicate documentation requests are made.

Customer Service and Communication

• 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 to include collaborating with internal teams as needed and ensuring timely follow-up.
• 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.

Patient Account Management and Collections

• 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.

Insurance and Billing Analysis

• 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, including claim review, over/underpayment identification, claim non-submittal, contractual adjustments, deductibles and overall patient responsibility.
• Ability to review claims and take appropriate action, including identifying why a claim denied and resubmitting for processing.
• Validating commercial insurance, including patient eligibility, referrals and authorizations as necessary to secure carrier payment.

Internal Communication and Collaboration

• 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.

GoHealth Core Values

GoHealth’s Core Values, listed below, are essential functions of this position:

• Collaboration: Takes ownership for collectively establishing productive partnerships and relationships and seek to gain joint understanding of priorities and objectives so that the greater good of the organization and those we serve is always at the forefront.
• Innovation: Consistently uses good judgment, applying creativity to overcome obstacles and increasing effectiveness and efficiency through process and other forms of innovation.
• Diversity & Inclusion:  Fosters diversity and inclusion, to be able to better understand team members, our customers and partners.  Engages the strengths and talents of each GoHealth team member, creating an environment of involvement, respect and connection where the richness of ideas, backgrounds and perspectives are harnessed.
• Courage & Integrity: Models and practices the highest ethical and professional standards; demonstrates pride and personal interest in our patients, partners and fellow team members, deeply engaging in the business. Makes decisions, with a focus on doing the right thing; treats team members, our customers, partners and vendors with dignity, consideration, open-mindedness and respect.
• Accountability: Always shows initiative, demonstrates a bias to action and gets things done. Actively accepts responsibility for diverse roles, obligations and actions that positively influence patient and customer outcomes, our partnerships and the healthcare needs of our communities.

Additional Requirements

• Office Environment: Tasks may be conducted within a climate-controlled office setting.
• Physical Activity: The role may require the ability to lift, carry, push, or pull materials, supplies, and equipment (up to 15 lbs.) Duties typically involve a combination of sitting, standing, and walking, with frequent changes in position.
• Travel: Travel may be required, including travel between facility locations, remote facilities, and out-of-town destinations as needed (0-10%)
• Safety Equipment: May require the use of safety equipment for infection prevention.

Internet Requirements for Remote Call Center Employees

To ensure an optimal and seamless customer experience, the following internet connection requirements must be met by all the call center employees working from home.

• Connection Type:
  • A hardwired (Ethernet) connection is mandatory to ensure stability and reliability.
  • Wireless (Wi-Fi) connections are not permitted for work purposes due to potential signal fluctuations, interference, and latency issues.
• Minimum Internet Speed:
  • Download speed: At least 100 Mbps
  • Upload speed: At least 10 Mbps
  • These speeds are required to handle voice, video calls, and data transmission simultaneously.
• Latency (Ping):
  • The network latency must not exceed 100ms to avoid delays in communication.
• Internet Service Provider (ISP):
  • The employee must subscribe to a reliable ISP that provide high-speed broadband services (e.g.,Fiber Optic, Cable).
  • DSL, satellite, or mobile hotspot connections are not recommended due to higher latency and potential service disruption.
• Backup Internet Connection (Optional but Recommended):
  • Employees should have a backup internet source (e.g.,secondary broadband or mobile data) in case of primary service disruption.
• Testing and Compliance:
  • Employees are required to perform a speed test using a reliable tool (such as Speedtest by Ookla) before the start of their shifts.
  • A record of compliance may be requested periodically to ensure adherence to these guidelines.
• Equipment:
  • Employees are responsible for ensuring that they have the appropriate modem, router, and Ethernet cable to meet these standards.
  • The router should be placed in a location that minimizes interference and maximizes the signal strength to the modem.

Note: This Job Description is not inclusive of all the duties of the position. You may be asked by Leaders to perform other duties. Leadership may revise this job description at any time.

Equal Employment Opportunity Statement

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.

ADA Accommodation Statement

Reasonable accommodations are available for qualified individuals with disabilities upon request. This role defines success by achieving essential function outcomes, not by the method of completion.

Compliance Statement

This job will be performed consistent with ADA, FMLA, FLSA, and other applicable federal, state, and local laws regulating employment.

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All qualified persons are granted an equal opportunity for employment without regard to race, color, religion, sex, sexual orientation and gender identity or expression, age, national origin, citizenship status, disability, genetic information, medical condition, family care leave status, pregnancy or pregnancy-related condition, otherwise qualified disabled or veteran status. The company will comply with all fair employment laws in each of the jurisdictions where we conduct business.

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