Department: Billing
Position: Patient Account Resolution Specialist
Exemption Status: Non-Exempt
Reporting Relationship: Patient Account Manager
Direct Reports: None
Work Environment: Office-Based
Position Summary
The Patient Account Resolution Specialist is responsible for resolving outstanding patient balances and supporting the overall financial health of the organization's self-pay accounts receivable portfolio. This role works directly with patients to collect outstanding balances, establish payment arrangements, answer billing questions, and provide exceptional customer service throughout the resolution process.
The Patient Account Resolution Specialist serves as a key liaison between patients, billing teams, clinic staff, and revenue cycle leadership to improve collections, reduce aging accounts receivable, and ensure patients receive accurate information regarding their financial obligations. This position plays a critical role in maximizing reimbursement while maintaining a positive patient experience.
Essential Duties and Responsibilities
Patient Account Resolution and Collections
- Contact patients regarding delinquent account balances through telephone, Artera, MyChart, letters, and other approved communication methods.
- Collect outstanding patient balances and establish payment arrangements in accordance with organizational policies.
- Negotiate and establish patient payment plans within approved guidelines.
- Monitor active payment plans and perform monthly follow-up to ensure compliance.
- Send patient statements, collection notices, and correspondence regarding outstanding balances.
- Review patient accounts and determine appropriate collection actions to improve self-pay accounts receivable performance.
- Maintain accurate documentation of collection activities, payment arrangements, and patient communications.
- Work assigned accounts receivable work queues to support collection and resolution efforts.
Customer Service and Patient Support
- Respond to patient billing inquiries and explain account balances, payment options, and billing information.
- Assist patients in understanding financial responsibilities and available payment solutions.
- Resolve routine patient account concerns while maintaining professionalism, empathy, and confidentiality.
- Assist front desk staff with patient billing inquiries and account-related questions.
- Assist with obtaining updated patient demographic and contact information when necessary.
Billing Support and Account Maintenance
- Initiate and respond to billing inquiries and requests for additional information.
- Perform approved write-offs, adjustments, refunds, and account corrections.
- Prepare itemized billing statements and supporting documentation as requested.
- Process medical records requests related to payer, attorney, or patient billing inquiries.
Collaboration and Communication
- Collaborate with Patient Account Leads, Patient Account Managers, Billing Specialists, and Revenue Cycle leadership to prioritize collection efforts.
- Participate in team meetings, training activities, and special projects as assigned.
- Communicate account concerns, trends, and process improvement opportunities to leadership
Compliance and Quality
- Maintain compliance with Medicare, Medicaid, HIPAA, and all applicable billing and collection regulations.
- Protect patient confidentiality and ensure proper handling of protected health information (PHI).
General Expectations
- Meet established daily, weekly, monthly, and annual productivity goals.
- Demonstrate initiative, ownership, and continuous effort toward improving reimbursement outcomes.
- Perform other duties as assigned.
Success Indicators / Key Performance Metrics
Success in this role may be measured by:
- Self-pay AR days
- Special program AR days
- Collection dollars recovered
- Payment plan compliance rates
- Timely account follow-up activity
- Customer service and patient satisfaction
- Documentation accuracy
Top performers consistently demonstrate persistence in collections efforts, excellent customer service, strong communication skills, timely payment plan management, and proactive problem-solving while maintaining positive patient relationships.
Required Qualifications
Education
- High school diploma or GED equivalent required
Experience
- One (1) to two (2) years of customer service, collections, billing, or office experience required
Certifications/Licensure
Technical Skills
- Strong verbal communication and customer service skills
- Attention to detail and accuracy
- Ability to navigate multiple software systems simultaneously
- Proficiency with Microsoft Office applications
- Ability to manage multiple priorities and deadlines
- Basic computer and data entry skills
Preferred Qualifications
- Experience working in a medical office, healthcare environment, or patient collections
- Experience handling sensitive customer conversations and payment arrangements
- Experience with Epic or other electronic medical record systems
- Ability to read and interpret Explanation of Benefits (EOBs)
- Working knowledge of CPT coding
- Bilingual English/Spanish
Working Conditions / ADA Requirements
- Prolonged sitting for extended periods
- Frequent computer use and data entry
- Frequent telephone communication
- Ability to maintain concentration while managing multiple accounts and deadlines
- Ability to communicate effectively verbally and in writing
- Occasional lifting and movement up to 25 pounds
- Office-based work environmet