Patient Account Representative

Patient Account Representative

The Patient Account Representative is responsible for supporting the hospital’s revenue cycle by performing a range of patient accounting functions, which may include medical billing, insurance follow-up, payment posting, and customer service. This role ensures the accurate processing of patient accounts and timely reimbursement from insurance carriers and patients while delivering excellent service to both internal and external stakeholders.

• Review and maintain patient account information to ensure accuracy of demographics, insurance coverage, and financial data.

• Communicate with patients, families, and clinical staff to obtain missing information or clarify account details.

• Review encounter documentation, charge information, and supporting records to prepare accurate claims.

• Apply appropriate coding standards (e.g., ICD-10, CPT, HCPCS) when required to ensure compliance with payer and regulatory guidelines.

• Verify insurance eligibility, benefits, and authorization requirements prior to claim submission.

• Prepare electronic or paper claims for submission to commercial payers, government programs, and other third-party entities.

• Ensure all required information, attachments, and documentation are included to support proper claim adjudication.

• Process claims using designated billing software and hospital information systems.

• Monitor outstanding accounts and follow up promptly on unpaid, denied, or delayed claims.

• Communicate with insurance carriers to determine claim status, resolve discrepancies, and obtain clarification on denial reasons.

• Investigate and correct errors related to coding, billing, or eligibility to facilitate payment.

• Submit appeals or corrected claims as needed.

• Accurately post insurance and patient payments, adjustments, and denials to the appropriate accounts.

• Reconcile daily payment reports and identify posting inconsistencies or missing items.

• Notify appropriate teams of trends or issues affecting reimbursement.

• Respond to patient inquiries regarding account balances, insurance billing, payment options, and financial assistance programs.

• Provide clear explanations of statements, benefits, and account activity in a professional and compassionate manner.

• Assist patients with setting up payment plans or directing them to financial counseling resources.

• Experience in hospital or physician practice billing, insurance follow-up, payment posting, or patient account services.

• Knowledge of medical terminology, billing regulations, and insurance processes.

• Strong communication, problem-solving, and customer service skills.

• Ability to work efficiently with electronic health records (EHR), billing software, and payer portals.