Patient Account Representative III

Job Summary

The Patient Account Representative III is responsible for processing assigned patient accounts from initial billing through collection of all amounts due from insurance carriers. This position works in accordance with established departmental and Health System policies, procedures, and standards while supporting efficient revenue cycle operations and patient satisfaction.

Essential Duties

• Ensure accuracy of account data and complete account checks, tasks, denial worklists, and credit balance worklists in Meditech.
• Review claim checks, holds, rejections, and RTPs in Ability and release claims to the appropriate payer.
• Submit CMS-1500 and/or UB-04 claim forms manually or electronically in a timely manner.
• Utilize insurance portals to verify eligibility, review claims processing, conduct appeals, and obtain explanation of benefits (EOBs).
• Perform follow-up activities on outstanding claims to secure reimbursement.
• Conduct insurance appeals and reconsiderations for denied or underpaid claims.
• Investigate claim issues, identify trends affecting reimbursement, and communicate concerns to management.
• Create clear and concise denial letters.
• Work Age Trial Balance (ATB) reports as directed by leadership.
• Respond to inquiries from patients, insurance carriers, and physicians regarding account status.
• Work independently and collaboratively within a team environment.
• Verify reimbursement amounts and process appropriate adjustment requests.
• Review credit balance accounts and take corrective action including adjustments or refunds.
• Document account activity, status, and expected resolution thoroughly.
• Generate patient correspondence when insurance carriers require additional information.
• Collaborate with leaders, team members, and departments to improve processes and patient satisfaction.
• Maintain confidentiality of employee, patient, and Health System information.
• Attend meetings and mandatory training sessions as required.
• Demonstrate Health System core values including quality, caring, ownership, pride, teamwork, respect, and responsibility.
• Participate in departmental performance improvement activities.
• Perform other duties as assigned.

Qualification Requirements

Education and License

• High School Diploma or equivalent, required.

Certifications

• No certifications required.

Experience

• Previous clerical work experience preferred.
• Minimum of two (2) years of billing and/or collections experience highly desirable.
• Experience working with computers and Microsoft Office Suite required.
• Any combination of education and experience that provides the necessary knowledge, skills, and abilities to perform the essential functions of the position.

Additional Qualifications

• Basic typing skills with accuracy and 10-key by touch.
• Detail-oriented with strong accuracy when working with figures and financial information.
• Ability to communicate clearly and effectively both verbally and in writing.
• Ability to maintain confidentiality of patient records and sensitive information.
• Ability to work effectively as part of a healthcare team and maintain cooperative working relationships.
• Strong customer service and interpersonal communication skills.
• Ability to communicate with patients, physicians, insurance carriers, and staff both in person and by phone.
• Ability to read and interpret billing requirements, regulations, medical reports, and related documentation.

Work Environment

Works indoors in an air-conditioned environment.

Physical Demands

Frequent use of computer and phone, and other standard office machines. Must be able to stand, sit, stoop, twist, kneel, reach, push, pull using proper body mechanics, and move/lift varying amounts of weight up to a maximum of 50 lbs.

Benefits

• Dental Insurance
• Disability Insurance
• Employee Assistance Program
• Flexible Spending Account (FSA)
• Health Insurance
• Life Insurance
• Paid Time Off (PTO)
• Retirement Plan
• Vision Insurance