The Patient Account Specialist supports the professional billing and revenue cycle activities of the Facial Plastic Surgery and Audiology Divisions within the Department of Otolaryngology. This position is responsible for ensuring timely and accurate charge entry, claim follow-up, denial resolution, insurance authorization, patient account support, and communication with departmental and medical group revenue cycle personnel.

The Patient Account Specialist works extensively within the Epic electronic medical record and billing system and serves as a resource for patients, providers, clinical staff, departmental leadership, and medical group representatives regarding billing and account-related matters.

General Billing and Revenue Cycle Responsibilities

• Review patient encounters and supporting documentation to ensure billing information is complete, accurate, and ready for claim submission.
• Enter, review, and reconcile professional charges within Epic in accordance with departmental procedures, payer requirements, and established billing timelines.
• Identify missing, incomplete, or inaccurate charges and communicate with providers and clinical staff to obtain necessary clarification or documentation.
• Monitor charge work queues, claim edit work queues, account follow-up work queues, and other assigned Epic revenue cycle reports.
• Review rejected and denied claims to determine the cause of the denial and complete the appropriate corrective action.
• Perform denial management activities, including claim correction, resubmission, reconsideration requests, appeal preparation, documentation review, and payer follow-up.
• Track recurring denial trends and communicate identified issues to departmental leadership, medical group revenue cycle personnel, providers, and clinical staff.
• Follow up on unpaid, underpaid, or incorrectly processed claims with insurance carriers and other third-party payers.
• Review accounts for appropriate insurance coverage, patient responsibility, contractual adjustments, and payment application.
• Assist with account reconciliation and resolution of outstanding balances.
• Respond to patient questions regarding charges, insurance processing, account balances, payment expectations, and billing statements in a professional and timely manner.
• Research patient inquiries within Epic and coordinate with the medical group, insurance carriers, or departmental staff as needed to resolve concerns.
• Document all account activity, payer communications, patient discussions, and follow-up actions accurately within Epic.
• Maintain confidentiality of patient, financial, and clinical information in accordance with HIPAA and organizational policies.
• Support compliance with applicable federal and state regulations, payer policies, coding requirements, and organizational billing standards.
• Assist departmental leadership with revenue cycle reports, account research, billing audits, and special projects.
• Participate in meetings with divisional leadership, providers, clinical staff, and medical group revenue cycle representatives as needed.
• Maintain current knowledge of payer requirements, Epic workflows, departmental billing procedures, and relevant revenue cycle policies.
• Perform other related duties as assigned.

Audiology and Hearing Aid Responsibilities

• Support billing activities for audiology diagnostic services, hearing aid evaluations, hearing aid devices, hearing aid fittings, repairs, supplies, accessories, and related services.
• Verify patient insurance benefits and coverage requirements for hearing aid services and devices.
• Obtain prior authorizations, pre-certifications, or other payer approvals required for hearing aid devices and related services.
• Submit required clinical documentation, medical necessity information, hearing test results, physician orders, device information, and other supporting materials to insurance carriers.
• Monitor pending hearing aid authorization requests and follow up with payers, patients, audiologists, and clinical staff until a determination is received.
• Communicate authorization approvals, denials, coverage limitations, patient responsibility, and expiration dates to the appropriate audiology staff.
• Track authorization effective dates, approved devices, service limitations, and payer-specific requirements to help prevent avoidable denials.
• Assist with appeals or reconsideration requests for denied hearing aid authorizations when appropriate.
• Review hearing aid charges for accuracy, including device type, laterality, quantity, payer requirements, and supporting documentation.
• Assist patients with questions regarding insurance benefits, hearing aid coverage, deposits, balances, and payment expectations.
• Coordinate with audiologists and hearing aid staff to resolve billing, authorization, documentation, or account-related issues.

Facial Plastic Surgery and Cosmetic Billing Responsibilities

• Support billing activities for medically necessary and cosmetic services provided by the Facial Plastic Surgery Division.
• Maintain accurate cosmetic billing records, payment information, procedure documentation, deposits, account balances, and related financial tracking.
• Enter and reconcile cosmetic charges and payments in accordance with departmental and medical group procedures.
• Review cosmetic accounts to confirm that charges, payments, adjustments, and balances are accurately recorded.
• Assist with the preparation, maintenance, and communication of cosmetic fee schedules and pricing information.
• Respond to patient questions regarding cosmetic procedure pricing, deposits, payment expectations, account balances, and billing policies.
• Clearly distinguish cosmetic services from insurance-billable services and assist with appropriate account handling.
• Communicate regularly with the medical group regarding cosmetic billing, payment posting, account reconciliation, financial reporting, billing workflows, and identified account discrepancies.
• Serve as a departmental point of contact for communication between the Facial Plastic Surgery Division and the medical group regarding cosmetic billing matters.
• Assist in resolving discrepancies involving cosmetic charges, deposits, payments, refunds, adjustments, and account balances.
• Maintain appropriate documentation of cosmetic financial arrangements and patient communications.
• Support departmental leadership with cosmetic billing reports, account reviews, reconciliation activities, and related financial projects.

Minimum Qualifications and Skills:

• Previous medical billing, patient account, revenue cycle, or healthcare financial services experience.
• Experience working with medical insurance claims, claim follow-up, denial management, charge entry, payment review, or patient account resolution.
• Working knowledge of medical terminology, insurance billing processes, and patient account procedures.
• Proficiency with computers and standard office applications.
• Ability to manage confidential patient and financial information appropriately.
• Strong written and verbal communication skills.
• Strong organizational skills and attention to detail.
• Ability to prioritize multiple assignments and meet established deadlines.
• Ability to work independently and collaboratively with providers, clinical staff, patients, insurance carriers, and revenue cycle personnel.
• Knowledge of medical billing, insurance verification, claims processing, denial management, and patient account follow-up.
• Ability to navigate Epic work queues, patient accounts, charge review functions, claim information, and account documentation.
• Ability to interpret payer correspondence, explanation of benefits documents, remittance information, and authorization requirements.
• Ability to research and resolve billing discrepancies accurately and efficiently.
• Ability to communicate financial information clearly and professionally to patients.
• Ability to maintain positive working relationships with departmental staff, medical group personnel, insurance representatives, and patients.
• Ability to recognize recurring billing issues and escalate concerns appropriately.
• Ability to exercise sound judgment, maintain professionalism, and provide excellent customer service.
• Ability to maintain accuracy while working in a high-volume and deadline-driven environment.
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Preferred Qualifications:

• Certified Professional Coder certification is not required but is preferred.
• Experience using Epic electronic medical record and revenue cycle applications preferred.
• Experience with professional billing, denial management, prior authorization, or specialty practice billing preferred.
• Previous experience with audiology, hearing aid, otolaryngology, surgical, or cosmetic billing preferred.
• Experience obtaining insurance authorizations for hearing aids, durable medical equipment, devices, or specialty services preferred.
• Familiarity with cosmetic service billing, patient deposits, payment arrangements, and account reconciliation preferred.