Patient Account Representative 2

University of Washington•Seattle, WA

About The Position

UW Medicine’s Patient Financial Services is hiring a Patient Account Representative 2. This role supports patient account resolution by preparing and submitting billing forms and electronic claims, researching insurance claim status and payer requirements, addressing denials and rejections, and determining appropriate actions for unresolved accounts. The representative also processes accounts receivable adjustments and insurance credit balances, updates patient and payer information, communicates with Medical Center staff and third-party payers, and maintains tracking tools and documentation.

Requirements

High school graduation or equivalent.
Two years of experience in patient accounting, customer service, or a related office environment.
Equivalent education and/or experience may substitute for minimum qualifications, except where legal requirements apply.

Nice To Haves

Knowledge of UB, CMS-1500, ADA, and other billing forms and payer requirements.
Knowledge of Epic Hospital Billing and/or SBO billing and registration systems.
Experience in hospital or SBO patient financial services, insurance billing, claims processing and follow-up, denials, appeals, underpayments, or other business-office patient account insurance billing and follow-up functions.

Responsibilities

Edit, prepare, and submit UB-04, CMS-1500, ADA, and other applicable billing forms and electronic claims in accordance with regulatory requirements.
Analyze unresolved insurance accounts, including denied, rejected, unpaid, underpaid, suspended, or otherwise unresolved claims, and take appropriate action.
Research claim status, payer processing requirements, eligibility, benefits, authorizations, medical necessity requirements, and payment discrepancies.
Review payer denials and claim rejections and determine appropriate corrective actions, such as correction, rebilling, reconsideration, appeal, adjustment, or other payer follow-up.
Review the entire patient account and use independent judgment to determine an appropriate resolution based on claim history, payer responses, payments, adjustments, and outstanding balances.
Prepare and/or process Accounts Receivable adjustments in accordance with departmental policies, payer requirements, contractual terms, and adjustment guidelines.
Analyze insurance credit-balance accounts and resolve payer overpayments, duplicate payments, and payment-posting discrepancies.
Use systems, payer portals, internal resources, and reference materials to obtain and verify insurance eligibility, benefits, coverage, authorization, claim status, and payment.
Update patient demographic, insurance, and payer information in applicable systems.
Communicate with Medical Center staff and third-party payers to obtain, verify, and resolve billing, claim, eligibility, authorization, payment, and reimbursement information.
Maintain spreadsheets, reports, and other tracking tools for account follow-up, workload management, payer activity, reimbursement analysis, and departmental reporting.
Use Microsoft Excel, Word, and other applicable software to prepare correspondence and documentation.