Patient Account Spec

The Clinic Patient Account Specialist serves as a key liaison among patients, insurance carriers, and rehabilitation staff to ensure that all insurance requirements for proposed therapy are accurately and efficiently managed. This role communicates anticipated patient financial responsibility, verifies insurance coverage, and supports Patient Financial Services with the management of claim denials. The specialist maintains current knowledge of major payers, coverage provisions, and regulatory requirements, consulting with rehab staff as needed for procedural and diagnostic information. Working collaboratively with the Clinic Billing Office and Hospital Business Office, the specialist resolves complex claim rejections and implements corrective actions to reduce future denial incidence, supporting both patient satisfaction and organizational revenue integrity.

Qualifications:

High School Diploma or Equivalent required. Previous healthcare or medical office experience preferred. Knowledge of healthcare medical terminology, ICD-10, CPT, and HCPCS codes preferred.

Primary Duties and Responsibilities:

Determines patient insurance coverage and obtains pre-authorization for therapy services in accordance with payer requirements. Processes therapy referrals, prioritizing urgent requests and ensuring timely access to care. Communicates accurately and professionally, both verbally and in writing, with insurance companies regarding requested services. Documents insurance findings, approvals, and authorization status in the electronic health record (EHR) promptly and accurately. Submits requests for insurance authorization within two business days of receiving a signed plan of care. Ensures that completed plans of care are sent to providers for signature within 30 days of evaluation or re-certification. Communicates effectively with patients, therapy department staff, billing personnel, and insurance representatives to facilitate smooth workflow. Maintains confidentiality of patient information and comply with HIPAA and organizational privacy standards. Tracks and maintains accurate records of all authorizations, referral statuses, and related documentation in the EHR. Assists in resolving insurance-related issues and coordinate with clinical and billing staff to support patient care and reimbursement processes. Follows department policies and procedures and participate in quality improvement initiatives, projects, or committees to enhance patient care and operational efficiency.

Skills and Abilities:

Knowledge of healthcare medical terminology, ICD-10, CPT, and HCPCS codes. Ability to communicate effectively and professionally with patients, clinical staff, and interdisciplinary teams, both verbally and in writing. Ability to process referrals efficiently, prioritize urgent requests, and manage time sensitive tasks. Ability to coordinate effectively with clinical, administrative, and billing teams to support patient care and reimbursement processes. Skilled in reviewing insurance plans and determining coverage for therapy services, including pre-authorization requirements. Skilled in using office equipment and technology, including computers, EHR systems, copiers, fax machines, 10-key calculators, and credit/debit card processing. Skilled in maintaining confidentiality and adhering to HIPAA regulations, organizational policies, and ethical standards.

Physical Demands and Work Environment:

Ability to occasionally lift and carry items weighing up to 20 pounds, such as files or office supplies. Ability to read, analyze, and interpret written materials. Ability to communicate effectively through reading, writing, and speaking in person or on telephone. Must be able to work at a computer for extended periods, including frequent viewing of a computer screen and prolonged sitting. Capable of performing effectively under pressure, managing stress constructively to meet organizational goals. Must be able to perform the primary duties and responsibilities of the job with or without reasonable accommodation.

Compensation:

$19.13- $26.36 DOE Benefits Health Insurance Vision Insurance Dental Insurance Flexible Spending Account (FSA and Health Savings Account (HSA) Options 401K Plan with Roth Options 401K 3% employer match and a 2% base non-elective employer contribution Eligibility for company-paid benefits such as life insurance and long-term disability, subject to applicable waiting periods Option to elect Supplemental employee, spouse, and child life insurance Paid Time Off (PTO) Access to the

Employee Assistance Program Discounts:

available for meals in the cafeteria and over-the-counter pharmacy items

Exercise/Fitness Facility:

access to the Rehab Therapy Fitness Center for the employee and dependents

Mission :

Grande Ronde Hospital and Clinics will ensure access to high quality, cost-effective health care in a safe and customer-friendly environment for all those in need of our services.

Vision :

Quality health care is our mission. Patients are our passion.

Values :

Creativity, Compassion, Collaboration, Credibility