Account Services Specialist Jobs

Overview

Position Summary

The Patient Account Services Specialist supports the financial, insurance, authorization, contracted program, and administrative functions of Elevate Mental Wellness. The role works closely with patients, providers, pharmacies, insurance companies, billing personnel, contracted partners, and administrative staff to support timely reimbursement and continuity of care.

Essential Duties and Responsibilities

Patient Accounts and Payment Processing

• Post insurance and patient payments, contractual adjustments, and other account activity.
• Review EOBs, ERAs, and payment reports for accuracy.
• Review patient balances and identify incorrect charges, discrepancies, or unresolved balances.
• Monitor and assist with self-pay and sliding-fee-scale accounts.
• Answer patient billing questions and assist with payment arrangements.
• Conduct collection follow-up and document payment activity and patient communications.

Claims and Denial Follow-Up

• Review rejected, denied, and unpaid claims and determine appropriate follow-up.
• Contact insurance companies to verify claim status and resolve billing or insurance issues.
• Submit corrected claims, reconsiderations, and appeals as appropriate. Monitor deadlines.
• Gather and submit required supporting documentation, including clinical records, authorization information, and proof of timely filing.
• Track outstanding claims through final resolution and document insurance contacts and follow-up.
• Identify recurring denial trends and report concerns to the Director of Practice Operations.

Medication Prior Authorizations

• Receive and process medication prior authorization requests.
• Submit requests through CoverMyMeds, insurance portals, fax, telephone, or other systems.
• Gather required information from the patient record, including diagnosis, medication history, previous trials, treatment response, and supporting documentation.
• Coordinate with prescribing providers when additional information is required.
• Follow requests through determination and respond to requests for additional documentation.
• Document approvals, effective and expiration dates, quantity limits, requirements and restrictions.
• Notify appropriate providers, pharmacies, patients, and staff of authorization outcomes.
• Assist with reconsiderations, appeals, and peer-to-peer requests as directed.
• Track pending and expiring authorizations to help prevent interruptions in medication access.

Service and Out-of-Network Authorizations

• Verify insurance benefits and authorization requirements for behavioral health services.
• Request authorizations for visits, evaluations, testing, and other services.
• Submit requests for out-of-network benefits, network-gap exceptions, single-case agreements, and continuity-of-care consideration when applicable.
• Coordinate with providers to obtain required clinical and medical-necessity documentation.
• Track authorization requests and document approved services, CPT codes, visits or units, auth. numbers, effective dates, expiration dates, and limitations.
• Communicate authorization and financial information to patients and appropriate staff.

PACE and Contracted Program Support

• Support administrative, authorization, billing, and documentation requirements related to Elevate Mental Wellness’s PACE contract and other assigned programs.
• Coordinate documentation and communication with PACE representatives and Elevate providers.
• Ensure required information is submitted within applicable program or contract timeframes.
• Escalate unresolved barriers or contract-related concerns to the appropriate supervisor.

Fax and Document Processing

• Monitor incoming electronic fax systems throughout the workday.
• Review and route incoming faxes to the appropriate provider, department, or staff member.
• Process pharmacy requests, authorization notices, insurance correspondence, medical records, referrals, laboratory results, hospital records, and billing documents.
• Upload documents into the correct patient chart and document category.
• Verify patient identity before filing or routing records.
• Promptly route urgent or time-sensitive information to the appropriate provider or supervisor.
• Send outgoing faxes and follow up on failed or incomplete transmissions.

Performance Expectations

• Complete assigned work accurately and within required deadlines.
• Maintain clear documentation and consistent follow-through.
• Communicate unresolved issues or barriers promptly.
• Maintain confidentiality and comply with HIPAA and Elevate Mental Wellness policies.
• Reduce preventable denials, payment delays, incorrect balances, and interruptions in patient care.

Qualifications

• Previous experience in medical billing, healthcare administration, and patient accounts management.
• Behavioral health experience preferred.
• Knowledge of commercial insurance, Medicaid, Medicare, and healthcare payer processes.
• Experience with EOBs, ERAs, denials, appeals, prior authorizations, and insurance portals.
• Strong organizational, time-management, and follow-through skills.
• Strong attention to detail and accuracy and ability to manage multiple priorities.
• Strong written and verbal communication skills.
• Ability to communicate professionally with patients regarding financial matters.
• Ability to maintain confidentiality and appropriately handle protected health information.
• Proficiency with electronic health records, Microsoft applications, electronic fax systems, insurance portals, and other administrative technology.

Reports To: Director of Administration & Practice Operations

Pay: $56,000.00 per year

Benefits:

• 401(k)
• Flexible schedule
• Health insurance
• Paid time off

Experience:

• Medical office: 2 years (Required)

Work Location: In person