Patient Accounts Representative - Monday-Friday - Day Shift

Missouri Delta Medical Center•Sikeston, MO

18h•Onsite

About The Position

The Patient Accounts Representative is responsible for timely, accurate, and compliant processing of healthcare claims and ongoing management of patient accounts receivable for hospital and professional services. The role includes insurance billing, claims submission, payment and denial follow-up, account reconciliation, and resolution of outstanding insurance balances. The representative maintains assigned payer accounts, investigates billing discrepancies, claim rejections, and denials, and ensures claims meet applicable federal and state regulations, payer-specific guidelines, contractual requirements, and Missouri Delta Medical Center policies. The position requires working knowledge of healthcare revenue cycle processes, insurance reimbursement methodologies, UB-04 and CMS-1500 claim forms, and governmental and commercial payer requirements. The representative is accountable for assigned work queues, accurate account documentation, and established productivity and quality expectations, and identifies opportunities to prevent recurring billing errors and reimbursement delays. The position reports directly to the Revenue Cycle Director or designated leadership. The representative works independently and communicates and collaborates with other departments, insurance carriers, patients, and external business partners. This is an on-site role in Sikeston, Missouri, with a Monday-Friday day shift.

Requirements

High school diploma or equivalent required.
At least six months to one year of experience in healthcare claims billing, medical accounts receivable, insurance follow-up, or a related revenue cycle position required.
Working knowledge of healthcare revenue cycle processes and insurance claims management.
Understanding of UB-04 and CMS-1500 billing requirements.
Familiarity with CPT, HCPCS, ICD-10-CM, revenue codes, modifiers, and medical terminology.
Knowledge of Medicare, Medicaid, and commercial insurance billing guidelines.
Ability to interpret EOBs, ERAs, denial codes, and payer correspondence.
Strong analytical, organizational, and problem-solving skills.
Excellent verbal and written communication skills.
Ability to manage multiple priorities, meet deadlines, and work independently with minimal direct supervision.
Proficiency in Microsoft Office applications and general computer navigation.
Ability to adapt to changing payer regulations, billing requirements, and departmental workflows.
Professionalism, initiative, accountability, attention to detail, and dependable attendance.

Nice To Haves

Additional education in medical billing, coding, healthcare administration, or business administration.
Medical billing and/or coding certification.
Experience with hospital or physician billing.
Experience working with Medicare, Medicaid, and commercial insurance payers.
Experience with electronic health records, patient accounting systems, clearinghouses, and payer portals.

Responsibilities

Review and process assigned accounts, verify billing information and insurance coverage, and submit accurate claims within payer and regulatory filing deadlines.
Apply knowledge of UB-04 and CMS-1500 claim formats, payer-specific guidelines, reimbursement methodologies, and contractual requirements.
Review claims for completeness, resolve claim edits and rejections, and identify accounts requiring additional documentation or supporting information.
Work assigned insurance accounts and electronic work queues according to departmental priorities, aging requirements, and productivity expectations.
Follow up on unpaid, underpaid, and outstanding claims; investigate claim status, payment delays, processing errors, and reimbursement discrepancies with insurance carriers.
Review accounts receivable aging and other available reports or resources, prevent avoidable timely-filing write-offs, and maintain ownership of assigned accounts through resolution.
Investigate and resolve eligibility, coordination-of-benefits, authorization, medical necessity, payer enrollment, and other insurance processing issues.
Analyze denials, rejections, and payment discrepancies; determine corrective actions and prepare and submit appeals and supporting documentation within payer deadlines.
Identify denial trends and root causes, document denied claims, and collaborate with Patient Access, HIM, Case Management, Clinical Departments, and other personnel to resolve reimbursement issues.
Review insurance payments, contractual adjustments, and patient responsibility amounts; assist with remittance processing and payment posting as assigned.
Identify underpayments, overpayments, credit balances, incorrect adjustments, charge or reimbursement discrepancies, and other payment variances, and resolve or escalate them appropriately.
Apply contractual allowances and adjustments according to payer contracts and departmental policies, and ensure patients are billed only for amounts determined to be their responsibility.
Maintain working knowledge of Medicare, Missouri Medicaid, managed care, commercial insurance, and other payer requirements; use payer portals, clearinghouse applications, and other electronic resources to research claims and reimbursement.
Perform billing and collection activities in compliance with applicable regulations, HIPAA requirements, payer contracts, and organizational policies, while maintaining confidentiality of patient information.
Maintain timely and complete account documentation, including calls, payer correspondence, claim inquiries, denial research, appeals, and follow-up actions; attach supporting documents to the appropriate account or record.
Communicate professionally with insurance representatives, patients, vendors, and internal departments; respond to patient billing inquiries and route questions requiring additional assistance.
Coordinate with external billing vendors and business office partners and escalate unresolved issues, complex accounts, and potential compliance concerns.
Meet established productivity, quality, accuracy, and turnaround-time expectations; follow departmental procedures and maintain proficiency with assigned systems and applications.
Identify workflow improvements and opportunities to reduce preventable denials and improve reimbursement turnaround; participate in meetings, training, continuing education, and performance improvement initiatives.
Complete required annual competency assessments and assist with training new employees and cross-training as assigned.
Support the organization's mission, vision, values, policies, and conduct rules; maintain professional conduct, dependable attendance, and cooperative working relationships.
Perform other duties as assigned by departmental leadership.