Overview
The Patient Account Representative is responsible for managing patient accounts to ensure timely resolution. This role requires a solid understanding of the revenue cycle, covering the entire life of a patient account from creation to payment. The representative will follow up on claim submissions, review remittances for insurance collections, and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare, and Medicaid insurance is preferred.
This position requires the ability to work independently as well as collaboratively with management and team members to resolve accounts efficiently.
Responsibilities
- Perform assigned duties professionally, interacting with insurance plans, patients, physicians, attorneys, and team members as needed.
- Utilize basic computer skills to navigate various system applications and resources for account management.
- Access payer websites to obtain relevant data for account resolution.
- Use available job aids to ensure appropriate patient accounting processes.
- Document clear and concise notes in the patient accounting system regarding claim status and actions taken.
- Maintain daily productivity goals by completing assigned accounts while meeting quality standards.
- Identify and communicate issues such as system access problems, payer behavior, workflow inconsistencies, or other insurance collection opportunities.
- Provide support to team members during absences or backlogs.
- Research accounts using patient accounting applications and internet resources.
- Contact third-party payers and/or patients via phone, email, or online to resolve uncollected balances.
- Problem-solve issues to generate revenue and reduce rework.
- Update plan IDs, adjust patient or payer demographic/insurance information, and document account details.
- Identify payer issues and trends, resolve recoupment issues.
- Request additional information from patients, medical records, or other documentation as needed.
- Review contracts to identify billing or coding issues and request re-bills, secondary billing, or corrected bills.
- Take appropriate action to resolve accounts timely or open dispute records for further research.
- Maintain desk inventory to avoid backlog while achieving productivity and quality standards.
- Assist with special projects, documenting findings and communicating results.
- Recognize potential delays and trends with payers and respond to avoid accounts receivable aging.
- Escalate payment delays or problem accounts to supervisors promptly.
- Participate in meetings, training seminars, and in-services to develop job knowledge.
- Respond timely to emails and telephone messages.
- Ensure compliance with State and Federal laws and regulations for Managed Care and other third-party payers.
Requirements
- High school diploma or equivalent; some college coursework in business administration or accounting preferred.
- 1-4 years of medical claims and/or hospital collections experience.
- Minimum typing speed of 45 words per minute.
- Thorough understanding of the revenue cycle process from patient access through billing, insurance appeals, and collections.
- Intermediate skills in Microsoft Office (Word, Excel).
- Ability to quickly learn hospital systems such as ACE, VI Web, IMaCS, and OnDemand.
- Clear and professional communication skills, both oral and written.
- Strong interpersonal skills.
- Above average analytical and critical thinking abilities.
- Ability to make sound decisions.
- Full understanding of Commercial, Managed Care, Medicare, and Medicaid collections.
- Intermediate knowledge of Managed Care contracts, contract language, and federal and state requirements for government payers.
- Familiarity with terms such as HMO, PPO, IPA, and Capitation and their claim processing.
- Intermediate understanding of Explanation of Benefits (EOB).
- Intermediate knowledge of hospital billing forms (UB04) and familiarity with HCFA 1500 forms.
- Ability to problem solve, prioritize duties, and follow through on assigned tasks.
Physical Demands
- Ability to sit and work at a computer terminal for extended periods.
- Work performed in an office/team environment.
Work Environment
- Call center environment with multiple workstations in close proximity.
Compensation & Benefits
- Hourly pay range: $15.80 - $23.70, depending on location, qualifications, and experience.
- Position may be eligible for a signing bonus for qualified new hires.
- Time and a half pay for observed holidays.
- Benefits include medical, dental, vision, disability, and life insurance.
- Paid time off (minimum 12 days per year, accruing approximately 1.84 hours per 40 hours worked).
- 401(k) plan with up to 6% employer match.
- 10 paid holidays per year.
- Health savings accounts, healthcare and dependent flexible spending accounts.
- Employee assistance and discount programs.
- Voluntary benefits such as pet insurance, legal insurance, accident and critical illness insurance, long-term care, elder and childcare, AD&D, auto and home insurance.
- For Colorado employees, paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.
Additional Information
- Candidates may be required to obtain and provide confirmation of all required vaccinations and screenings prior to employment, including but not limited to COVID-19 and influenza vaccinations.
- Employment practices comply with all applicable laws and regulations and do not discriminate based on legally protected statuses.
- Reasonable accommodations are available for qualified individuals with disabilities.