Patient Financial Support Specialist

This role is responsible for managing patient account receivables, outbound and inbound patient collection activities, payment resolution, and customer service support for Commonwealth Pain & Spine. This role serves as a critical liaison between patients, clinic operations, and the Revenue Cycle Management (RCM) department to ensure timely and accurate resolution of patient balances while delivering a high level of professionalism and compassion.

The ideal candidate possesses strong healthcare insurance knowledge, exceptional patient service skills, collections experience, and proficiency within AthenaOne worklists and patient account workflows. This position requires the ability to manage sensitive financial conversations while maintaining compliance with company policies, payer guidelines, and applicable federal and state regulations.

This role reports directly to the Patient AR Manager.

Patient Account Resolution & Collections

• Manage assigned patient AR portfolios and collection worklists within AthenaOne

• Conduct outbound and inbound collection calls regarding patient balances, payment plans, and account resolution

• Review and resolve patient balances including:

o Copays

o Deductibles

o Coinsurance

o Self-pay balances

o Prior balances

o Bad debt prevention efforts

• Maintain professional, empathetic, and solution-oriented communication with patients regarding financial obligations

• Negotiate and establish approved payment arrangements according to company policy

• Monitor aging accounts and prioritize high-risk or escalating balances

• Escalate complex account issues, complaints, or compliance concerns appropriately

AthenaOne Worklist Management

• Effectively manage AthenaOne patient AR worklists and queues daily

• Review account notes, claim history, payment posting activity, and correspondence for accurate follow-up

• Document all patient interactions thoroughly and accurately within AthenaOne

• Maintain timely follow-up cycles and ensure worklists remain current and actionable

• Identify workflow inefficiencies and recommend process improvements to leadership

Insurance & Financial Knowledge

• Demonstrate strong understanding of:

o Commercial insurance plans

o Medicare

o Medicaid

o Managed care plans

o Patient responsibility calculations

o EOB interpretation

o Coordination of benefits

o Prior authorization impacts on patient liability

• Assist patients in understanding insurance processing and financial responsibility

• Research denied or incorrectly adjudicated patient balances when appropriate

• Collaborate with Insurance AR teams to resolve payer-related discrepancies impacting patient balances

Patient Service & Support

• Deliver exceptional customer service while handling sensitive financial discussions

• Support patients with:

o Billing questions

o Statement inquiries

o Online payment guidance

o Financial assistance routing

o Payment plan setup

• De-escalate challenging patient interactions professionally and effectively

• Maintain confidentiality and HIPAA compliance at all times

Compliance & Operational Standards

• Follow Fair Debt Collection Practices Act (FDCPA) guidelines and applicable state regulations

• Maintain compliance with organizational collection policies and procedures

• Adhere to all HIPAA, payer, and company confidentiality standards

• Support departmental goals related to cash collections and patient satisfaction

• Participate in departmental meetings, training sessions, and workflow initiatives

Required Qualifications

• High school diploma or equivalent required

• Minimum 2–3 years of healthcare patient AR or medical collections experience preferred

• Strong working knowledge of healthcare insurance and patient responsibility

• Prior experience with AthenaOne strongly preferred

• Experience working in physician practice, pain management, ASC, or multispecialty healthcare environment preferred

• Strong verbal communication and customer service skills

• Ability to manage difficult conversations professionally

• Strong organizational skills and attention to detail

• Intermediate computer and Microsoft Office skills

Key Performance Indicators (KPIs) Financial Performance

• Monthly patient collection goals achieved

• Reduction in patient AR aging over 90 days

• Payment plan conversion rates

• Bad debt prevention performance

Productivity Metrics

• Daily outbound call volume

• 50-70 Accounts worked per day/week

• AthenaOne worklist completion rates

• Timely account follow-up compliance

Quality Metrics

• Real-time Documentation accuracy within AthenaOne

• Patient satisfaction and service quality

• Call quality audit scores

• Compliance adherence and audit accuracy

Operational Metrics

• 24 hour Response time to patient inquiries

• Same Day/Next Day Resolution turnaround time

• Reduction in unresolved patient account escalations

• Work queue aging management as per AthenaOne Best Practices

Department: Revenue Cycle Management (RCM) Classification: Full-Time

FLSA Status: Non-Exempt