EDUCATION & EXPERIENCE: Minimum Qualifications: - Two years of financial experience or one year of patient accounts experience. Preferred Qualifications: - Experience with patient account follow-up, including contacting insurance payers to obtain claim status updates. - Experience researching and resolving insurance claim denials. - Experience using Epic Resolute preferred. JOB SUMMARY: The Patient Account Specialist will be responsible for billing all third-party payers through a claims processing vendor and/or for appeal of denied professional and/or hospital claims. Identifies billing issues affecting hospital and/or physicians claims/accounts and takes necessary action to ensure timely and appropriate claim filing. Performs follow-up activities and identifies reimbursement issues affecting these claims. Takes necessary actions to ensure timely and appropriate reimbursement and account resolution. ESSENTIAL JOB FUNCTIONS: - Demonstrates a level of competence and understanding of all state and federal laws, rules, and regulations regarding payer billing guidelines - Demonstrates a basic understanding of CPT, ICD-9, HCPCS, modifier coding as well as POS requirements - Billing payers and/or clients for hospital and/or Professional Patient Accounts - Resolves Payer rejections from billing system daily to bill submit hospital and/or physicians claims - Performs online corrections to edited claims according to procedures - Performs detailed follow-up activities on assigned accounts according to procedures - Responds to daily correspondence according to procedures - Identifies denials and underpayments for appeal - Reviews, researches, and processes denied claims - Appeal claims as appropriate according to policies and procedures - Updates account information and documents as appropriate within Epic Resolute - Processes account adjustments according to policies/procedures - Issues payer and/or patient refunds according to policies/procedures - Validates accuracy of payments and/or adjustments on accounts - Resolves outstanding accounts at required accuracy and productivity requirements - Maintains comprehensive knowledge of the work unit assigned - Assists in the development of department policies and procedures - Adheres to established policies and procedures - Adheres to internal controls and reporting structure - Maintains open and professional communication with customers, colleagues, and vendors - Performs well in a team environment Marginal or Periodic Functions: - Successfully completes competency-based training and testing - Prioritizes and completes all work in an accurate, effective, and efficient manner - Particip