Patient Accounts Representative

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Description

SUMMARY:

The Patient Accounts Representative is responsible for managing the full lifecycle of insurance claims, ensuring accurate billing, timely reimbursement, and exceptional communication with patients, payers, and internal departments. This role requires strong analytical skills, attention to detail, and the ability to navigate complex payer requirements across Medicare, Medicaid, and commercial insurance plans.

ESSENTIAL FUNCTIONS:

• Performs proactive follow-ups on insurance claims with Medicare, Medicaid, and commercial payers to drive timely resolution of outstanding balances and reduce aging accounts.
• Reviews, analyzes, and resolves denied or rejected claims by identifying root causes, correcting errors, and submitting accurate documentation to payers.
• Contacts patients to obtain missing information, clarify billing concerns, and provide clear updates on claim status and financial responsibilities.
• Maintains detailed, compliant records of all claim activity, payer interactions, and follow-up actions within internal systems to support audit readiness.
• Partners with billing, coding, verification and external vendors to insure accuracy and address system issues contributing to denials.
• Tracks payer behavior and reimbursement patterns, escalating issues to leadership to support process improvements and revenue protection.
• Assists the verification team as needed to confirm patient eligibility and benefits, preventing avoidable claim delays.
• Identifies overpayments for both patients and insurance carriers, prepares refund requests with proper documentation, and notifies management promptly.
• Answers inbound calls from patients, attorneys, and other stakeholders, providing accurate information and resolving billing-related inquiries.
• Monitors and maintains accounts receivables by processing aging reports and specific workflows as indicated by the collection procedures for each payer type.
• Refers accounts to Patient Account Supervisor/Manager, as needed.
• Performs other duties as assigned.

QUALIFICATIONS:

• High School Diploma or GED equivalent.
• Minimum of three (3) years of experience in medical billing, insurance follow-up, or healthcare accounts receivable.
• Knowledge of medical terminology, ICD-10 coding, and insurance claim filing processes.
• Understanding of Medicare, Medicaid, commercial insurance, and ambulance billing policies and procedures.
• Experience resolving denied or rejected claims and working payer accounts receivable.
• Proficient in Microsoft Office, including Excel and Word, and billing system software.
• Strong communication, organizational, and customer service skills.
• Ability to multi-task, prioritize workload, and work effectively in a fast-paced environment.
• Must have been excluded by the OIG to Participate in Federally Funded Health Care Programs

PHYSICAL REQUIREMENTS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

• Sit for extended periods of time
• Walk, stand, bend, squat, twist and reach
• Simple grasping and fine manipulation
• Extended keyboarding

WORKING CONDITIONS

• Air-conditioned office environment