Job description

The Patient Account Representative’s responsibilities include liaising with medical insurance providers to process claims in a timely and accurate manner, resolve payment issues, assist patients in understanding insurance claims, and processing patient payments and refunds. A successful Patient Account Representative should be detail-oriented and knowledgeable of medical terminology and billing. Ultimately, an outstanding Patient Account Representative should demonstrate exceptional communication skills necessary to work effectively with insurances and patients in processing accounts in a timely and accurate manner.

DUTIES AND ESSENTIAL JOB FUNCTIONS

This job description covers or contains a listing of most activities, duties, or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

• Work accounts receivable assignments efficiently and timely while maintaining expected performance goals.
• Identify problem accounts with payers by investigating, analyzing, and correcting errors
• Conduct follow up on outstanding accounts by calling insurance companies or utilizing the payer web portals. Properly documents detail notes on every account preparing for the next course of action and or resolution
• Research denied claims as well as underpayments from third-party payers and processes appeals and/or claim(s) reconsiderations to insurance companies in a timely manner
• Ability to identify trends and repeated problems and report them to management for evaluation
• Process patient payments and refunds.
• Work with insurance companies to determine benefits for procedures, surgeries, and clinic services in order to estimate patients’ financial responsibility.
• Ability to analyze and understand written communication from insurance companies, including but not limited to, explanation of benefits, correspondence, and requests for additional information to process claim(s) in a timely and accurate manner.
• Contact patients and collects prepayments and/or outstanding balances.

QUALIFICATIONS

Required

High school diploma or general education degree (GED) and one (1) year related experience in a medical office or hospital setting with experience processing professional fee claims

Preferred

Oncology experience

CPT-Coding/Billing, Continuing Education Coding classes

Knowledge of medical terminology and office billing

Knowledge of electronic medical records (EMR), patient management (PM) system(s), insurance payer portals, and clearinghouse(s) necessary to utilities these resources to effectively work assigned tasks and responsibilities