Patient Account Representative

Patient Account Representative

The Patient Account Representative's responsibilities include liaising with medical insurance providers to process claims in a timely and accurate manner, resolve payment issues, assist patients in understanding insurance claims, and processing patient payments and refunds.

To be successful as a Patient Account Representative, one should be detail-oriented and knowledgeable of medical terminology and billing. Ultimately, an outstanding Patient Account Representative should demonstrate exceptional communication skills necessary to work effectively with insurances and patients in processing accounts in a timely and accurate manner.

Duties and essential job functions include:

• Work accounts receivable assignments efficiently and timely while maintaining expected performance goals.
• Identify problem accounts with payers by investigating, analyzing, and correcting errors
• Conduct follow up on outstanding accounts by calling insurance companies or utilizing the payer web portals. Properly documents detail notes on every account preparing for the next course of action and or resolution
• Research denied claims as well as underpayments from third party payers and processes appeals and/or claim(s) reconsiderations to insurance companies in a timely manner
• Ability to identify trends and repeated problems and report them to management for evaluation
• Process patient payments and refunds.
• Work with insurance companies to determine benefits for procedures, surgeries, and clinic services in order to estimate patient's financial responsibility.
• Ability to analyze and understand written communication from insurance companies and other third parties, including but not limited to, explanation of benefits, correspondence, and requests for additional information to process claim(s) in a timely and accurate manner.
• Contact patients and collects prepayments and outstanding balances.
• Interacts with patients when eligibility and benefits cannot be verified through the various payer portals, etc.
• Interacts with patients to assess eligibility for financial assistance programs/grants and assists them with the application process(es).
• As appropriate, obtains prepayment(s)/payment arrangement(s) for patients receiving cancer therapy, other USA services, and outstanding balances. All other reasonable duties, as assigned.

Competencies include:

• Customer Service
• Interpersonal Skills
• Oral Communication
• Written Communication
• Teamwork
• Diversity
• Ethics
• Organizational support
• Planning/Organizing
• Professionalism
• Quantity
• Safety and Security
• Adaptability
• Attendance/Punctuality
• Dependability
• Initiative
• Innovation

Other skills and abilities:

• Remain calm and professional in stressful situations.
• Friendly, courteous, service-oriented, and flexible and enjoy working with a variety of staff.
• Detail-oriented and work effectively under pressure while meeting all applicable deadlines.
• Must be able to work independently and productively with minimum supervision, able to manage multiple projects.
• Recognize problems, identify possible causes, and resolve routine issues.
• Establish and maintain effective working relationships with internal and external organizations, groups, team members, and individuals.

Qualifications:

Required:

High school diploma or general education degree (GED) and one (1) year related experience in a medical office or hospital setting with experience processing professional fee claims

Preferred:

CPT-Coding/Billing, Continuing Education Coding classes

Knowledge of medical terminology and office billing

Knowledge of electronic medical records (EMR), patient management (PM) system(s), insurance payer portals, and clearinghouse(s) is necessary to utilize these resources to work assigned tasks and responsibilities effectively