Patient Account Representative - Medicare, Medicaid, Commercial Claims

Guidehouse•San Antonio, TX

10d•Hybrid

About The Position

The Insurance Patient Account Representative acts as an extension of a client’s business office staff, handling incoming and outgoing calls with patients and insurance companies to resolve account balances while following client policies and procedures. The role includes account review, appeals and denials, Medicare and Medicaid work, insurance follow-up, customer service, billing, and work involving UB-04 and CMS 1500 forms. Representatives handle 40–70 accounts per day, respond to patient inquiries by telephone and mail, update demographic information, initiate account adjustments, and attempt to resolve balances before accounts are referred to an outside collections agency. The representative also completes assigned projects and business-related requests, assists clients and patients, and communicates concerns or improvement opportunities to Guidehouse management. The position follows a hybrid schedule, with two days in the San Antonio, Texas office and three days working from home. Travel and security clearance are not required.

Requirements

High school diploma or GED, or three years of relevant equivalent experience in lieu of a diploma or GED.
0–2+ years of experience in an office, business, operations, customer service, or healthcare field.

Nice To Haves

Previous experience working in insurance portals.
PC skills in a Windows environment.
Knowledge and use of desktop applications, including Word and Excel.
Ability to initiate and follow through on projects and work independently with minimal supervision.

Responsibilities

Review patient accounts and resolve account balances.
Handle appeals, denials, Medicare and Medicaid accounts, insurance follow-up, customer service, and billing.
Use UB-04 and CMS 1500 billing forms.
Complete business-related requests and correspondence from patients and insurance companies.
Work 40–70 accounts per day.
Complete assigned projects in a timely manner.
Assist clients and patients with requested tasks.
Communicate areas of concern and opportunities for improvement to Guidehouse management.
Research and respond to patient inquiries received by telephone and mail.
Update patient demographic information and initiate account adjustments.
Attempt to resolve account balances before forwarding accounts to an outside collections agency.
Follow client policies and procedures and perform other assigned job-related duties.

Benefits

Medical, prescription, dental, and vision insurance.
Personal and family sick time and company-paid holidays.
May be eligible for a discretionary variable incentive bonus.
Parental leave.
401(k) retirement plan.
Basic life and supplemental life insurance.
Health Savings Account and dental/vision and dependent care Flexible Spending Accounts.
Short-term and long-term disability.
Tuition reimbursement, personal development, and learning opportunities.
Skills development and certifications.
Employee referral program.
Corporate-sponsored events and community outreach.
Emergency back-up childcare program.