Patient Accounts Representative

Position Summary
The Patient Accounts Representative provides positive and effective customer service that supports departmental and hospital operations. This role is responsible for managing patient accounts, verifying insurance information, submitting accurate claims, resolving billing issues, and ensuring timely communication with patients, families, payers, and internal departments. The Patient Accounts Representative works closely with physician offices, service sites, and ancillary departments to support accurate billing and account resolution.
Highly preferred candidates will have experience with hospital-based billing and collections, a strong understanding of payer processes, and knowledge of CPT codes and medical billing practices. Candidates with experience resolving insurance claims, working with payers, and supporting revenue cycle operations are strongly encouraged to apply.

Key Responsibilities

• Verify and update patient demographic, insurance, referral, and authorization information to ensure accurate account processing.
• Confirm insurance eligibility using payer websites, available technology, and communication with third-party payers.
• Prepare and submit accurate insurance claims within required timeframes.
• Review claims for accuracy, resolve billing errors, and address claim processing issues with payers.
• Work payer scrubber and denial reports to identify and resolve outstanding insurance claims.
• Research and prepare payer appeals and provide necessary documentation to support claim payment.
• Maintain clear and accurate account notes documenting all actions taken.
• Collaborate with clinical departments, physician offices, referral/authorization teams, and other internal partners to resolve account issues.
• Monitor trends related to denials, claim errors, and payer issues and escalate concerns as appropriate.
• Maintain a working knowledge of third-party payer contracts and hospital billing processes.
• Participate in process improvement initiatives and departmental projects.

Minimum Qualifications
Education:

• High school diploma or GED required.

Experience:

• Previous medical billing experience, preferably working with automated billing systems, is preferred

Knowledge, Skills, and Abilities:

• Strong attention to detail with excellent organizational skills.
• Ability to analyze and interpret routine account and billing information.
• Strong written and verbal communication skills with the ability to interact professionally with patients, families, hospital employees, and external partners.
• Ability to provide empathy and support when handling difficult patient or billing situations.
• Ability to work effectively with diverse internal and external teams.
• Strong computer skills and ability to accurately enter and retrieve information from automated systems.
• Ability to manage priorities and meet deadlines in a team-oriented environment.

Schedule:
Full-time-hybrid /remote

The posted pay range is Boston Children's reasonable and good-faith expectation for this pay at the time of posting.

Any base pay offer provided depends on skills, experience, education, certifications, and a variety of other job-related factors. Base pay is one part of a comprehensive benefits package that includes flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.