Patient Account Representative

Responsible for revenue cycle processes for professional billing, including data entry, charge processing, claims management, claim edits, claim denials, patient and insurance refunds, and accounts receivable follow-up.

Key responsibilities include:

• Review work queues and prioritize tasks to ensure timely follow-up on patient accounts.
• Confirm pre-bill edits are cleared and required signatures are obtained before billing.
• Gather documentation needed to respond to initial data requests and appeals.
• Answer inquiries from patients and insurance companies regarding charges and billing discrepancies.
• Track denied claims and appeals, including payments and adjustments.
• Review explanation of benefits and remittance advices to resolve accounts and pursue appropriate follow-up.
• Support charity allowance documentation and collection referrals when needed.
• Assist with orientation and training of new employees or volunteers.
• Attend meetings and seminars with insurance plans, medical groups, and IPAs.
• Document detailed notes, action items, and correspondence activity.
• Resolve payer issues and patient billing complaints, escalating issues to management as appropriate.
• Issue denial letters within required timeframes.
• Perform collection actions with patients, insurance companies, and third-party payers.
• Prepare write-off requests for denied claims that cannot be appealed.
• Review claim scrubber results and correct claim edits.
• Access computer systems to retrieve patient information.
• Review patient accounts with credit balances and submit refund requests when appropriate.