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Healthcare and Wellness

Patient Account Representative Full Time

Summary:

The Patient Account Representative is responsible for working patient accounts and resolving them in a timely manner. The role involves follow-up on claim submission, insurance collections, and dispute management across government and non-government entities. The candidate must have knowledge of Commercial, Managed Care, Medicare, and Medicaid insurance. The position requires independent work, problem-solving skills, and teamwork in a dynamic environment.

Responsibilities:

  • Perform duties as assigned in a professional manner, including interacting with insurance plans, patients, physicians, attorneys, and team members as needed.
  • Use computer skills to navigate various system applications to determine account actions.
  • Access payer websites to resolve accounts.
  • Utilize job aids for appropriate Patient Accounting processes.
  • Document clear and concise notes regarding claim status and actions in the patient accounting system.
  • Maintain daily productivity goals and meet quality standards.
  • Identify and communicate system access issues, payor behavior, account workflow inconsistencies, or insurance collection opportunities.
  • Provide support for team members who may be absent or backlogged.
  • Research accounts using company applications and internet resources.
  • Conduct appropriate account activities on uncollected balances, including contacting third-party payors and patients via phone, email, or online.
  • Problem-solve and create resolutions that bring in revenue and eliminate rework.
  • Update plan IDs, adjust patient or payor information, and notate accounts with detailed actions taken.
  • Request additional documentation from patients, medical records, or other sources when needed.
  • Review contracts, identify billing or coding issues, and request re-bills, secondary billing, or corrected bills.
  • Take appropriate action for account resolution and open dispute records for further research.
  • Maintain current desk inventory and achieve productivity and quality standards.
  • Perform special projects as assigned and communicate findings.
  • Recognize potential delays or trends with payors and escalate payment delays or aged accounts to supervisors.
  • Attend meetings, training seminars, and in-services for job knowledge development.
  • Respond to emails and telephone messages promptly.
  • Ensure compliance with State and Federal laws for Managed Care and other Third-Party Payors.

Requirements:

  • High School diploma or equivalent. Some college coursework in business administration or accounting preferred.
  • 1-4 years of medical claims and/or hospital collections experience.
  • Minimum typing speed of 45 wpm.
  • Thorough understanding of the revenue cycle process, from patient access to Patient Financial Services procedures and policies.
  • Intermediate skill in Microsoft Office (Word, Excel).
  • Ability to learn hospital systems quickly and fluently.
  • Strong communication skills, both oral and written.
  • Strong interpersonal skills and critical thinking ability.
  • Ability to make sound decisions and problem-solve.
  • Full understanding of Commercial, Managed Care, Medicare, and Medicaid collections.
  • Knowledge of Managed Care contracts, contract language, and Federal/State requirements for government payors.
  • Familiarity with terms such as HMO, PPO, IPA, and Capitation and how these payors process claims.
  • Intermediate understanding of EOB and hospital billing form requirements (UB04, HCFA 1500 forms).
  • Ability to prioritize and complete assigned tasks.

Benefits:

  • Medical, dental, vision, disability, and life insurance.
  • Paid time off (vacation & sick leave) – minimum of 12 days per year.
  • 401k with up to 6% employer match.
  • 10 paid holidays per year.
  • Health savings accounts, healthcare & dependent flexible spending accounts.
  • Employee Assistance program and Employee discount program.
  • Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long-term care, elder & childcare, AD&D, auto & home insurance.
  • Paid leave for Colorado employees in accordance with Colorado’s Healthy Families and Workplaces Act.

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