Job Description

Job Summary

The Patient Accounts Analyst I is responsible for managing all aspects of the revenue cycle for assigned clinic locations, ensuring timely and accurate resolution of system edits, insurance denials, and patient billing issues. This role serves as a subject matter expert in billing and revenue cycle transactions, working closely with clinic staff and corporate teams to optimize financial performance. The Patient Accounts Analyst I also tracks, reviews, and reports on billing metrics and trends, providing insights to improve revenue cycle processes.

Essential Functions

Receive and process IDR case submissions from eligible parties. Review documentation for completeness, eligibility, and compliance with federal/state IDR criteria. Coordinate the selection and communication with Certified IDR Entities or arbitrators. Monitor timelines and ensure all parties meet deadlines as required by law. Maintain accurate case files and document all communications and decisions. Respond to inquiries from stakeholders including providers, payers, legal representatives, and regulatory agencies. Track and report key performance indicators and outcomes of IDR cases. Assist with process improvements and implementation of regulatory updates. Support training initiatives and help maintain up-to-date standard operating procedures. Ensure strict confidentiality and data privacy in accordance with HIPAA and other applicable laws. Reviews workflow dashboards and accounts receivable (AR) aging reports to identify trends in key financial performance indicators (KPIs) affecting clinic revenue cycle outcomes. Researches and resolves billing delays, insurance denials, and payment discrepancies, ensuring timely submission and payment of accounts. Performs root cause analysis to identify recurring issues in billing workflows and collaborates with clinic personnel to prevent reoccurrence. Processes account adjustments in accordance with PPS/CHS policies and compliance regulations. Provides training and education to clinic personnel on billing policies, system workflows, and best practices for revenue cycle efficiency. Documents all communication, training sessions, and issue resolutions between clinic staff, corporate personnel, and revenue cycle teams to maintain accurate records. Maintains current knowledge of federal and state billing regulations, ensuring compliance with payer guidelines and revenue cycle best practices. Identifies and escalates complex issues outside standard workflows, ensuring timely resolution through the appropriate leadership channels. Performs other duties as assigned. Complies with all policies and standards.

Qualifications

H.S. Diploma or GED required Associate Degree or higher in Healthcare Administration, Business, Accounting, or a related field preferred 1-2 years of experience in medical billing, patient accounts, insurance claims processing, or revenue cycle operations required Experience working with Athena, Epic, or other practice management systems preferred

Knowledge, Skills and Abilities

Strong understanding of medical billing processes, revenue cycle workflows, and payer reimbursement policies. Proficiency in Athena, Microsoft Excel, and other billing/accounting systems. Ability to analyze and interpret revenue cycle data, identifying trends and process improvement opportunities. Excellent communication and interpersonal skills, with the ability to train and support clinic personnel. Strong problem-solving and critical-thinking skills, with the ability to research and resolve complex patient account issues. Ability to work independently while maintaining a collaborative approach to revenue cycle optimization.