Patient Account Representative

Patient Account Representative

Company: Conifer Health Solutions

The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. The representative will need to effectively follow‑up on claim submission, review remittance for insurance collections, and pursue disputed balances from both government and non‑government entities.

Basic knowledge of Commercial, Managed Care, Medicare, and Medicaid insurance is preferable. An effective revenue cycle process is achieved by working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving accounts with minimal assistance.

• Research each account using company patient accounting applications and internet resources that are made available. Conduct appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e‑mail, or online. Problem solve issues and create resolution that will bring in revenue eliminating re‑work.
• Update plan IDs, adjust patient or payor demographic/insurance information, notate account in detail, identify payor issues and trends, and solve re‑coup issues.
• Request additional information from patients, medical records, and other needed documentation upon request from payors.
• Review contracts and identify billing or coding issues and request re‑bills, secondary billing, or corrected bills as needed.
• Take appropriate action to bring about account resolution timely or open a dispute record to have the account further researched and substantiated for continued collection.
• Maintain desk inventory to remain current without backlog while achieving productivity and quality standards.
• Perform special projects and other duties as needed. Assist with special projects as assigned, document findings, and communicate results.
• Recognize potential delays and trends with payors such as corrective actions and respond to avoid A/R aging. Escalate payment delays/problem aged account timely to Supervisor.
• Participate and attend meetings, training seminars and in‑services to develop job knowledge.
• Respond timely to emails and telephone messages as appropriate.
• Ensure compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors.

• Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies.
• Intermediate skill in Microsoft Office (Word, Excel).
• Ability to learn hospital systems – ACE, VI Web, IMaCS, OnDemand quickly and fluently.
• Ability to communicate in a clear and professional manner; strong interpersonal skills.
• Good oral and written skills. Above‑average analytical and critical thinking skills.
• Sound decision‑making ability.
• Full understanding of Commercial, Managed Care, Medicare, and Medicaid collections; intermediate knowledge of Managed Care contracts, contract language, and federal and state requirements for government payors.
• Familiarity with terms such as HMO, PPO, IPA and Capitation and how these payors process claims.
• Intermediate understanding of EOB.
• Intermediate understanding of Hospital billing form requirements (UB04) and familiarity with the HCFA 1500 forms.
• Ability to problem‑solve, prioritize duties and follow through completely with assigned tasks.

• High School diploma or equivalent. Some college coursework in business administration or accounting preferred.
• 1‑4 years of medical claims and/or hospital collections experience.
• Minimum typing requirement of 45 wpm.

• Office/Team Work Environment.
• Ability to sit and work at a computer terminal for extended periods of time.

• Call Center environment with multiple workstations in close proximity.

• Pay: $15.80 – $23.70 per hour. Compensation depends on location,…