Patient Account Representative

Jack Hughston Memorial Hospital•Columbus, GA

11d

About The Position

The Patient Account Representative processes electronic and paper claims for the facility and follows accounts through the complete claims adjudication cycle. The role reviews claim errors, audit trails, and electronic and paper remittances; corrects and resubmits claims; and conducts follow-up to resolve denials and outstanding accounts receivable. The representative maintains accurate account notes and billing status, monitors payer requirements and applicable guidelines, and supports other Business Office functions as needed.

Requirements

High school diploma or equivalent.
Good math skills.
Proficiency in Microsoft Word, Excel, and PowerPoint.
Exceptional customer service skills.
Strong verbal and non-verbal communication skills.
Valid driver’s license and satisfactory Motor Vehicle Record (MVR).

Nice To Haves

Relevant previous billing or insurance collections experience; 2–4 years in healthcare is preferred.
Certified Patient Accounts Representative (CPAR) or Certified Revenue Cycle Representative (CRCR) certification.

Responsibilities

Process inpatient and outpatient claims downloaded from the mainframe through the electronic billing system for all payers.
Monitor and resolve outstanding accounts receivable balances promptly, using effective collection techniques to meet aging targets: 31–60 days at or below 15%, 61–90 days at or below 8%, and over 90 days at or below 12%.
Identify and correct claims that error in the billing system before transmission to third-party payers.
Identify missing claim audits related to coding and collaborate with coding staff to obtain appropriate codes.
Process late charges according to departmental procedures.
Work denials in the Waystar Denial Management system and update their status weekly.
Report billing, registration, and posting errors or issues to the Team Lead or Director.
Review payer audit trail reports, correct rejected claims, and resubmit them to payers.
Recommend front-end edits for the electronic billing software.
Review, monitor, or respond to correspondence within 48 hours of receipt.
Update patient accounts with current billing status and clear, detailed notes.
Determine payment status using online claim-status tools, voice or fax systems, and direct telephone inquiries to insurance company representatives.
Resolve denials by preparing appeals, obtaining medical records, writing appeal letters, and submitting required documentation or corrections.
Work accounts receivable and credit balance reports weekly and maintain various reports.
Review explanations of benefits to verify correct claim payment and posting and appropriate transfer of patient financial responsibility in the system.
Prepare detailed account adjustment recommendations based on research and interpretation of account activity.
Report errors and issues to management and monitor compliance with payer contracts and federal and state guidelines.
Maintain knowledge of payer contracts to work accounts receivable accurately.
Complete payer-required reports, including the Medicaid Cross Over report, Medicare Quarterly Credit Balance report, and Medicare Bad Debt report.
Assist and participate in other Business Office areas as needed to achieve departmental goals.
Meet assigned productivity goals of 95% or higher and quality assurance goals of 2.8 or higher.
Prioritize and organize work, manage time effectively, maintain current accounts receivable balances, and reduce accounts receivable aging over 30 days.