The Patient Billing & Collections Specialist is responsible for the analysis, resolution, and collection of complex self-pay patient accounts, requiring a strong working knowledge of healthcare billing workflows, collections regulations, and financial assistance programs. This role applies critical thinking and independent judgment to evaluate account activity, determine appropriate resolution pathways, and ensure compliance with federal, state, and payer-specific requirements. The Specialist partners closely with Billing, Coding, Financial Counseling, and external vendors to drive timely, accurate account resolution while delivering a high level of patient-centered service.
MISSION, VALUES and SERVICE GOALS
- MISSION: We deliver outstanding care, inspire health, and connect with heart.
- VALUES: Trust. Respect. Integrity. Compassion.
- SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.
- Analyze and resolve complex patient billing and self-pay accounts, including disputes, bankruptcy, probate, financial assistance eligibility, denials, refunds, and bad-debt placement.
- Conduct proactive follow-up on outstanding patient balances using multiple communication channels to secure payment, establish payment plans, or determine alternative resolution options.
- Apply critical thinking to assess account history, billing accuracy, insurance activity, and regulatory constraints to determine the most appropriate next steps.
- Explain billing statements, insurance adjustments, denials, and patient payment responsibility clearly and professionally.
- Evaluate Financial Assistance applications for completeness, eligibility, and compliance with organizational policy and regulatory requirements; communicate determinations in a timely manner.
- Establish and manage payment plans in accordance with internal policies and vendor guidelines.
- Process account adjustments, write-offs, refunds, rebilling, and corrections with a high degree of accuracy.
- Collaborate with Billing, Coding, and Financial Counseling teams to ensure accounts are financially cleared and accurately resolved.
- Monitor performance and outcomes of self-pay and collection vendors; identify trends, risks, or issues and escalate findings to management.
- Maintain accurate, detailed, and compliant account documentation following each account review or patient interaction.
- Meet or exceed established productivity, quality, and collection performance goals.
- Ensure compliance with HIPAA, Fair Debt Collection practices, and all applicable healthcare billing and collection regulations.
- Participate in training initiatives, audits, and continuous improvement efforts.
- Perform other duties as assigned.
ORGANIZATIONAL RESPONSIBILITIES
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Associate complies with the following organizational requirements:
- Attends and participates in department meetings and is accountable for all information shared.
- Completes mandatory education, annual competencies and department-specific education within established timeframes.
- Completes annual employee health requirements within established timeframes.
- Maintains license/certification, registration in good standing throughout fiscal year.
- Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
- Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
- Adheres to regulatory agency requirements, survey process and compliance.
- Complies with established organization and department policies.
- Available to work overtime in addition to working additional or other shifts and schedules when required.
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Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:
- Leverage innovation everywhere.
- Cultivate human talent.
- Embrace performance improvement.
- Build greatness through accountability.
- Use information to improve and advance.
- Communicate clearly and continuously.
Qualifications
- High school diploma or equivalent (Associate degree preferred).
- 2+ years of experience in healthcare billing, patient collections, or self-pay account follow-up.
- Demonstrated understanding of medical billing processes, insurance claim workflows, and account reconciliation.
- Working knowledge of financial assistance and charity care programs, including eligibility guidelines.
- Familiarity with medical terminology, CPT/ICD-10 coding concepts, and common payer denial scenarios.
- Strong analytical skills with the ability to interpret account data, identify root causes, and resolve billing discrepancies.
- Proficiency in Microsoft Office applications (Excel, Word, Teams).
- Excellent written and verbal communication skills with the ability to manage sensitive financial conversations professionally and empathetically.
- High attention to detail with strong organizational and time-management skills.
- Ability to work independently, exercise sound judgment, and meet deadlines.
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