Patient Account Representative

Patient Account Representative

The Patient Account Representative ensures the financial integrity of accounts receivable by performing established financial processes that enable and expedite billing and collection for medical services. This includes editing and resolving claims according to regulations and compliance guidelines, patient account research and resolution, insurance verification and benefit determinations, identification of reimbursement issues, resolution of credits and issuance of refunds, identification of payment variance on invoices and follow-up and resolution of denied claims. This role is responsible for working correspondence denials and insurance follow-up.

Core Leadership Standards & Competencies

• Review claims for accuracy according to current federal and payer guidelines and edit as needed to procure accurate and timely payment.
• Monitor and execute work on assigned claim worklists, AR worklists, reporting, projects, or team goals.
• Research and resolve claims based on assignment, which could include the following: contacting payers via phone or website, contacting practices, working across departments, writing appeals and facilitating their submission, and all other activities that lead to the successful adjudication of eligible claims.
• Run reports for analysis, trending, and subdivision of work to communicate with internal stakeholders.
• Manage and resolve posting issues, manage remittance and all correspondence in each of the EMR dashboards daily.
• Manage and resolve the zero-pay worklist and fully worked receivables, complete special project work, review and respond to adjustments and payment data, and communicate trends and root issues through proper lines of reporting.
• Illustrate excellent knowledge of healthcare industry regarding the revenue cycle, coding, claims, and state insurance laws.
• Ensure resolution of patient cases.
• Meet productivity standards as set by management.
• Maintain knowledge and understanding of insurance billing procedures to understand the reason for claims requiring edits to ensure resolution and timely payment.
• Educate and communicate revenue cycle/financial information to patients, payers, co-workers, managers and others as necessary to ensure accurate processes.