Patient Accounts Representative

The Patient Account Representative will be responsible for reviewing and auditing billing charges, billing, collection, straightforward coding, and all account receivable activities for the physician clinics within Saint Luke's Health System. Responsibilities Enter charge demographics. Troubleshoot charge‑related issues raised by clinic staff. Respond to inbound and outbound billing calls from patients. Post payments and resolve payment credits. Identify and correct medical claim errors that may prevent payment. Identify, correct, and resubmit medical claims denied by insurance companies. Resolve claim edits, work denials and appeals. Evaluate and code ICD, CPT, HCPCS. Apply all coding initiatives, NCCI edits, incidentals/inclusive, bundling rules, and other coding rules. Demonstrate competency for invalid diagnosis, modifiers, and coding‑related issues. Research patient billing claims to identify and correct coding/claim errors. Research patient insurance coverage to identify and resubmit claims to fix coverage denials. Research and outline documentation needed for respective payor organizations so that claims are processed correctly. Identify problem trends and communicate with payors for resolution of complications with claims. Handle 277 EDI transactions and rejections; work with EDI transactions. Make payment posting corrections/adjustments and distribute payments. Correct and enter charges. Work with multiple teams/departments to resolve issues. Coordinate payment plans or financial assistance. Research refund requests from payor organizations. Conduct preliminary audit of billing code errors before claim submission to the Coding team. Route complex claim denials to team lead or appropriate medical billing team. Identify issues that can be resolved by programming software to prevent denials. Become a subject‑matter expert on payor policies. Communicate and resolve problems with provider representatives. Write appeal letters to insurance companies and follow up on no‑response claims. Assist patient calls escalated from Customer Service regarding billing code issues. Perform simple level coding, including diagnosis review, modifier applications, and some CPT code changes following process documents and payor policies. Qualifications Minimum 1 year of experience. High‑school diploma required. Preferred: Billing or Coding Certifications. Must have anesthesia billing experience. Strong knowledge of NCCI edits, incidentals/inclusive, bundling rules, and coding standards. Proficiency with claim editing and working denials and appeals. Experience with 277 EDI transactions and payment posting. Excellent communication skills and ability to work cross‑functional teams. Saint Luke's is an equal‑opportunity employer. #J-18808-Ljbffr