Patient Account Representative - Medicare, Medicaid, Commercial Claims

Guidehouse•San Antonio, TX

9d•Hybrid

About The Position

The Insurance Patient Account Representative serves as an extension of a client’s business office staff, handling incoming and outgoing calls with patients and insurance companies to resolve account balances. The representative follows all client policies and procedures and performs other job-related duties as assigned. The position follows a hybrid schedule: two days in the San Antonio, Texas office and three days working from home. The role covers account review, appeals and denials, Medicare and Medicaid insurance follow-up, customer service, and billing using UB-04 and CMS 1500 forms. Representatives work 40–70 accounts per day, respond to patient inquiries by telephone and mail, update patient demographics, initiate account adjustments, and try to resolve balances before accounts are forwarded to an outside collections agency. They also complete assigned projects and business-related requests, assist clients and patients, and communicate concerns or improvement opportunities to Guidehouse management.

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

Complete business-related requests and correspondence from patients and insurance companies.
Work on 40–70 accounts per day.
Complete assigned projects in a timely manner.
Assist clients and patients with requested tasks.
Communicate areas of concern or improvement to Guidehouse management.
Research and respond to patient inquiries received by telephone and mail.
Update patient demographic information and initiate account adjustments.
Try to resolve account balances before accounts are forwarded to an outside collections agency.
Review accounts and handle appeals, denials, Medicare/Medicaid insurance follow-up, customer service, and billing.