Patient Account Representative

Job Description

Job Description

We are looking for a Patient Account Representative to support revenue cycle operations for healthcare accounts in Sacramento, California. This contract opportunity is ideal for someone who can balance accurate claim follow-up, strong payer knowledge, and responsive service when working with patients, providers, and insurance representatives. The person in this role will help resolve billing and reimbursement issues, monitor payment accuracy against contracted terms, and keep account activity moving forward in a fast-paced environment.

Responsibilities:
• Manage follow-up activities for patient accounts involving Medi-Cal and other insurance plans to drive timely resolution and payment.
• Review reimbursements against Medicare, Medi-Cal, and other payer agreements to confirm payments are processed at the correct contracted rates.
• Complete assigned NextGen work queues in accordance with departmental policies and established turnaround expectations.
• Submit account correction requests when adjustments are warranted and ensure documentation supports each change.
• Respond to inquiries from patients, clinics, physicians, and insurance carriers with clear and effective communication.
• Prepare and file first- and second-level appeals for denied, unpaid, or underpaid claims, and route higher-level appeals for review before submission.
• Process claim billing, including adding required chart notes, referrals, or other supporting records when necessary.
• Research eligibility, authorization, and insurance coverage details for preemie-related claims before billing activity begins.
• Resolve straightforward denial work items, post share-of-cost updates when patients pay directly, and escalate payer-specific concerns or trends to leadership.• At least 1 to 2 years of experience in healthcare billing, collections, patient accounts, or comparable industry training.
• Working knowledge of medical billing processes, denial management, insurance follow-up, and payment review practices.
• Familiarity with NextGen and the ability to manage assigned tasks efficiently within a billing workflow.
• Understanding of explanation of benefits documents, payer reimbursement guidelines, and insurance payment policies.
• Ability to navigate payer portals and evaluate whether claim payments align with expected contract pricing.
• Strong written and verbal communication skills with the ability to interact effectively with patients, payers, physicians, and internal teams.
• Proven ability to stay organized, adapt quickly to changing priorities, and perform well in a high-volume, deadline-driven setting.
• Customer-focused approach with professionalism, patience, empathy, and the ability to work both independently and collaboratively.