Patient Account Representative - Medicare, Medicaid, Commercial Claims

Job Family: Patient Account Representative | Travel Required: None | Clearance Required: None What You Will Do: The Insurance Patient Account Representative is an extension of a client’s business office staff. Representatives are responsible for taking in-coming and making out-going calls to patients and insurance companies to resolve account balances. All client policies and procedures are followed. Representatives will perform any and all job-related duties as assigned. Essential Job Functions Facilitates the billing and collection processes of outstanding accounts receivable. Communicates with internal and external contacts to explain primary, secondary and tertiary billing, collection, and resolution of claims, including Medicare and other government and nongovernment accounts. Monitors daily queues for customer service/quality and productivity to maintain acceptable levels as established by the department, alerting management of high call volume patterns. Handles incoming and outgoing billing correspondence and phone inquiries relating to patients, third‑party administrators, attorneys, vendors, and other insurance payers. Documents conversations and actions taken to support all claims inquiries, reviews, and/or reconsiderations, streamlining the follow‑up process for team members assisting on the file. Analyzes claims to determine compliant and accurate coding, charging, and reviews file to confirm demographic and billing information is updated. Works to resolve any claim or billing concerns and escalates issues to management when appropriate. Performs follow‑up processes on accounts to work toward a zero balance. Files a timely reconsideration or review of claim with supporting documentation such as a corrected claim, medical records, and letter of explanation as necessary, communicating with departments to gather information needed to resolve the claim. Performs balance transfers UB-04 & CMS 1500. Completes all business‑related requests and correspondence from patients and insurance companies. Responsible for working on average 35 accounts per day. Completes all assigned projects in a timely manner. Assists client and patients in all requested tasks. Communicates to Guidehouse management areas of concern or areas of improvement. Researches and responds to all patient inquiries received by telephone and mail. Updates patient demographic information and initiates account adjustments. Tries to resolve account balances to zero prior to accounts being forwarded to an outside agency for collections. What You Will Need: High School Diploma / GED or 3 years of relevant equivalent experience in lieu of Diploma / GED. 0-2+ years experience in office, business, operations, customer service or healthcare field. What Would Be Nice To Have: Previous experience working in insurance portals. PC skills in a Windows environment. Knowledge and utilization of desktop applications to include Word and Excel is essential. Ability to initiate and follow through on projects and work independently with minimal supervision. The annual salary range for this position is $34,000.00-$56,000.00. What We Offer: Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. Medical, Rx, Dental & Vision Insurance Personal and Family Sick Time & Company Paid Holidays Position may be eligible for a discretionary variable incentive bonus Parental Leave 401(k) Retirement Plan Basic Life & Supplemental Life Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts Short-Term & Long-Term Disability Tuition Reimbursement, Personal Development & Learning Opportunities Skills Development & Certifications Employee Referral Program Corporate Sponsored Events & Community Outreach Emergency Back-Up Childcare Program About Guidehouse Guidehouse is a global AI‑led professional services firm delivering advisory, technology, and managed services to the commercial and government sectors. With an integrated business technology approach, Guidehouse drives efficiency and resilience in the healthcare, financial services, energy, infrastructure, and national security markets. Built to help clients across industries outwit complexity, the firm brings together approximately 18,000 professionals to achieve lasting impact and shape a meaningful future. Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at View phone number on click.appcast.io or via email at View email address on click.appcast.io. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or View email address on click.appcast.io. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process. If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact View email address on click.appcast.io. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties. Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee. guidehouse.com #J-18808-Ljbffr US104 Guidehouse Managed Services LLC