Patient Accounts Representative

North Central Health Care•Wausau, WI

2d•Onsite

About The Position

The Patient Accounts Representative is responsible for accurate and timely billing of inpatient, outpatient, and ancillary services to commercial insurers, Medicare/Medicare Advantage, Medicaid/Medicaid HMOs, Workers’ Compensation/Liability carriers, and self-pay accounts. This position monitors accounts receivable, follows up on denials and underpayments, and ensures compliance with payer requirements, regulations, and organizational policies. The role also provides customer service to clients, families, and external parties regarding billing inquiries, payment arrangements, and account resolution.

Requirements

High school diploma or equivalent.
Minimum of 1 year of experience in healthcare billing or revenue cycle functions.
Applicants must be authorized to work in the United States without the need for current or future employer sponsorship, including but not limited to visa sponsorship or employment-based immigration support.

Nice To Haves

Associate degree in Health Information, Business, or a related field.
Experience with behavioral health billing and multiple payer types.

Responsibilities

Prepare and submit accurate claims to third-party payers and self-pay clients, ensuring compliance with payer rules and filing deadlines.
Rebill claims when necessary; submit secondary and corrected claims electronically or on paper as required.
Process refunds as necessary.
Audit self-pay bills to confirm accuracy and compliance with Wisconsin Administrative Code.
Monitor accounts receivable aging; research and resolve unpaid claims over established time thresholds.
Review payments, denials, and explanation of benefits (EOBs) for accuracy and appropriateness.
Initiate appeals, adjustments, transfers, write-offs, and refunds in accordance with policy.
Collaborate with collection agencies, when applicable, to ensure proper handling of accounts.
Investigate and resolve claim denials, underpayments, or incorrect reimbursements.
Communicate with insurance companies, providers, and internal departments to resolve billing and authorization issues.
Respond to client inquiries via phone or email, providing explanations of charges and account balances.
Communicate with external customers and families to provide itemized statements or resolve billing questions.
Work closely with Patient Access, Health Information Management, Utilization Review, Credentialing, and other departments to ensure accurate payer setup and claim resolution.
Process bankruptcy and probate according to established guidelines
Perform other duties as assigned.