Patient Account Rep

Torrance Memorial Medical Center•Torrance, CA

About The Position

The Patient Account Rep is responsible for professional-billing revenue cycle processes, including data entry, charge processing, claims management and editing, denial follow-up, patient and insurance refunds, and accounts receivable follow-up. The role reviews work queues, prioritizes account follow-up, clears pre-bill edits, and confirms required signatures are obtained before billing. It responds to patient and payer inquiries, reviews explanations of benefits and remittance advices, resolves account issues, and pursues appropriate billing, appeals, adjustments, or refunds. The position documents account activity and correspondence, tracks denied and appealed claims, prepares supporting documents for charity allowances or outside collections, and submits write-off requests for denied claims that cannot be appealed. It also identifies and resolves payer issues and patient billing complaints, escalates issues to the Manager when appropriate, and supports positive customer relations. Additional duties include assisting with new employee or volunteer orientation and training as assigned, attending meetings and seminars with insurance plans and medical groups, and completing department forms. The role requires adherence to established productivity standards and courteous, timely telephone service.

Requirements

At least 3 years of experience in physician billing.
Knowledge of ICD-10, CPT, and HCPCS coding.
Knowledge of LCD/NCD coding, including ensuring compliance with accepted guidelines.

Responsibilities

Review work queue status and prioritize job functions to ensure timely follow-up on patient accounts.
Confirm pre-bill edits are cleared and required signatures are obtained before billing.
Assist in gathering documentation for initial data requests and subsequent appeals.
Answer patient and insurance company inquiries about charges and billing discrepancies.
Track and report the status of denied claims and claims in the appeal process, including payments and adjustments.
Promote positive customer relations.
Review explanations of benefits and remittance advices and complete appropriate follow-up, including appeals, billing secondary insurers, or billing patients for unpaid balances.
Compile and submit supporting documentation for approval of charity allowances or referral to an outside collection agency.
Assist with orientation and training of new employees or volunteers, as assigned.
Attend meetings and seminars with insurance plans, medical groups, and IPAs.
Complete department forms as requested.
Document detailed notes on actions taken and incoming correspondence and inquiries from payers, patients, and other departments.
Escalate issues to the Manager as appropriate.
Identify and resolve payer issues and patient billing complaints; coordinate with appropriate personnel and insurance agencies and inform the Manager of outcomes.
Issue denial letters and mail them within the specified timeframe.
Perform collection actions by contacting patients, insurance companies, or third-party payers.
Prepare and submit write-off requests to the Manager for denied claims that cannot be appealed.
Respond to incoming correspondence and inquiries from payers, patients, and other departments in a timely and accurate manner.
Review explanations of benefits to resolve accounts.
Review the claim scrubber and resolve claim edits.
Access computer systems to retrieve patient information.
Review patient accounts with credit balances, make corrections if needed, and submit refund requests when appropriate.
Adhere to productivity standards established for the area.
Answer telephone calls courteously within three rings, identify self and department, route calls, ascertain needs, and take accurate messages as appropriate.