Billing FollowUp PT Acct

Patient Accounts Representative- Hospital Billing & Follow-Up

Summary

The Patient Accounts Representative- Hospital Billing & Follow-Up is responsible for ensuring the timely and accurate submission of inpatient and outpatient claims to government and commercial payers. This role identifies and resolves claim issues, supports revenue cycle operations, and helps accelerate cash collections while maintaining compliance with payer requirements and regulatory standards.

Essential Duties & Responsibilities

The duties listed below represent the primary responsibilities of this position. Additional duties may be assigned as needed.

Claims Processing & Billing

• Submit inpatient and outpatient electronic and paper claims (UB-04 and CMS-1500) to government and commercial payers.

• Review claims for completeness and accuracy before submission to ensure payer-specific requirements are met.

• Correct and resubmit rejected claims after resolving billing errors.

• Submit corrected claims when original claim information changes.

• Process late-charge claims when charges are entered after initial billing.

• Perform billing for complex scenarios, including interim, self-audit, combined, and split bills.

• Review imported claims and release, bill, or hold them for further review as appropriate.

• Place unbillable claims on hold and communicate necessary corrections to appropriate hospital departments.

Account Analysis & Follow-Up

• Analyze patient account and billing system information to determine appropriate billing and follow-up actions.

• Follow up on unpaid, denied, or unprocessed claims until resolution is achieved.

• Resolve questions regarding charges, services provided, and reimbursement concerns.

• Post accurate adjustments in accordance with billing policies, payer explanations of benefits (EOBs), and management directives.

• Generate letters and correspondence to insurance companies and patients to assist with claim resolution.

Documentation & Compliance

• Maintain clear, concise, and accurate account documentation.

• Create and maintain correspondence, emails, and supporting documentation, ensuring records are scanned to the appropriate account.

• Use approved abbreviations and documentation standards for consistency and clarity.

• Maintain strict compliance with HIPAA regulations and protect patient confidentiality at all times.

• Stay current on payer requirements, billing regulations, and government guidelines.

Communication & Customer Service

• Explain insurance benefits and billing information to patients, physicians, coworkers, and other stakeholders.

• Communicate effectively with payers through phone, mail, and online resources to resolve claim issues.

• Build and maintain positive working relationships with patients, coworkers, departments, and payer representatives.

• Report billing system, payer, or process issues to management in a timely manner.

Productivity & Operational Excellence

• Meet department productivity and quality standards established by leadership.

• Maintain a high level of accuracy and efficiency while adhering to organizational policies and procedures.

• Gather and process information that impacts patient revenue and reimbursement.

• Maintain and update spreadsheets and other tracking tools as required.

• Complete cross-training and special projects as assigned.

• Maintain work procedures relevant to assigned responsibilities.

• Work independently and exercise sound judgment in daily work activities.

• Take accountability for individual performance and work outcomes.

• Perform other duties as assigned.

Education & Experience

Minimum Education

• High school diploma or equivalent required.

Preferred Education

• College coursework or an Associate Degree preferred.

Experience

• Minimum of 3 years of hospital billing, claims follow-up, or revenue cycle experience preferred.

• Experience working with inpatient and outpatient claims, payer reimbursement processes, and revenue cycle operations strongly preferred.

Certificates, Licenses & Registrations

• No certifications or licenses are required for this position.