Patient Account Representative

Overview

We are seeking a full-time detail-oriented and organized Patient Account Representative to join our healthcare team. The ideal candidate will be responsible for managing billing processes, ensuring accurate and timely submission of claims, and maintaining patient records. This role ensures accurate claim submission, denial management, timely payments, and compliance with payer guidelines. The PAR supports, trains, and monitors billing and claims specialists to achieve productivity, quality, and reimbursement goals, while acting as the main point of escalation for claim resolution.

Qualifications

Proof of high school or equivalent or higher education required.2 years previous experience in healthcare or customer service preferred.

Preferred Qualifications

• Experience with Critical Access Hospital medical billing.
• Ability to work independently and manage multiple priorities.

Other education and experience may be substituted (if applicable) for the required minimum job qualifications with the approval of the Corporate Director of Human Resources.

Responsibilities

Responsibilities

• Works on billing operations for hospital services.
• Ensure accurate and timely submission of claims to all insurance including but not limited to Medicare, Medicare Advantages, Medicaid, Commercial Insurance.
• Review and resolve claim denials, rejections, and underpayments.
• Ensure compliance with state, federal, and payer-specific billing regulations
• Prepare and submit accurate billing claims to insurance companies and government agencies.
• Review patient records for completeness and accuracy before billing.
• Maintain detailed records of all billing transactions and correspondence.
• Stay updated on changes in healthcare regulations and billing procedures to ensure compliance.
• Collaborate with other departments to clarify any issues related to billing or coding.
• Reporting & Communication
• Collaborate with intake, authorization, and clinical teams to ensure complete and accurate billing data.
• Communicate with payers on escalated claims and reimbursement issues.
• Initiate Acute and Swingbed authorizations when received from Case Management.
• Any other duties as assigned by management.

Experience

• High School Diploma required
• Knowledge of Medicare, Medicaid, and Commercial Insurance
• Strong understanding of hospital revenue cycle processes
• Experience with EMR systems
• Proficiency in payer portals (i.e. Availity, United Healthcare etc.)
• Excellent organizational and time-management skills.
• Strong problem-solving and analytical abilities for claim resolution.
• Effective written and verbal communication.
• Intermediate Excel skills (reporting, reconciliation).
• Familiarity with medical terminology, coding systems (such as ICD-10, CPT), and insurance processes is a plus.
• Strong attention to detail and ability to work independently while managing multiple tasks.