Patient Financial Service Representative

The Patient Financial Services Representative is responsible for reviewing patient accounts to ensure accurate patient balances, resolving patient billing inquiries and escalations, and working directly with patients and insurance carriers to address account discrepancies. This role serves as a key liaison between patients, clinics, and the Revenue Cycle Management team to ensure patients receive clear, accurate billing information and that all balances are appropriately adjudicated before patient responsibility is assigned.

The ideal candidate has strong healthcare billing knowledge, excellent customer service skills, and the ability to independently investigate account issues, verify insurance coverage, refile claims when appropriate, and resolve complex patient billing concerns with professionalism and empathy.

The Patient Financial Services Representative is responsible for reviewing patient accounts to ensure accurate patient balances, resolving patient billing inquiries and escalations, and working directly with patients and insurance carriers to address account discrepancies. This role serves as a key liaison between patients, clinics, and the Revenue Cycle Management team to ensure patients receive clear, accurate billing information and that all balances are appropriately adjudicated before patient responsibility is assigned.

The ideal candidate has strong healthcare billing knowledge, excellent customer service skills, and the ability to independently investigate account issues, verify insurance coverage, refile claims when appropriate, and resolve complex patient billing concerns with professionalism and empathy.

• Manage escalated patient billing inquiries received through phone, email, tickets, and clinic referrals.
• Research patient accounts to identify the root cause of billing concerns and provide clear explanations to patients.
• Resolve disputes related to patient balances, insurance processing, payments, adjustments, refunds, and billing questions.
• Maintain professional and empathetic communication with patients while adhering to company policies.
• Escalate unusual, high-risk, or compliance-related issues to leadership when appropriate.

• Review self-pay and patient responsibility accounts to ensure balances are accurate and supported by claims adjudication.
• Analyze EOBs, ERAs, payment postings, adjustments, and account activity to validate patient balances.
• Identify potential billing errors, missing insurance payments, duplicate charges, incorrect adjustments, or misapplied payments.
• Recommend and process account corrections according to established policies and procedures.
• Document findings and resolutions thoroughly within the practice management system.

• Identify accounts that should be billed or rebilled to insurance rather than assigned to patient responsibility.
• Verify payer eligibility, coverage, and coordination of benefits when applicable.
• Refile corrected claims and submit claim reconsiderations as needed.
• Research claim denials and rejections impacting patient balances.
• Collaborate with AR, billing, payment posting, credentialing, and clinic teams to ensure accurate claim outcomes.

• Perform insurance verification for patients when coverage questions arise.
• Confirm eligibility, benefits, coverage limitations, copays, deductibles, coinsurance, and authorization requirements.
• Update patient accounts with accurate insurance information.
• Communicate insurance findings to patients and internal teams.

• Educate patients regarding their financial responsibility and available payment options.
• Assist patients with financial hardship requests, payment plan inquiries, and account resolution options.
• Support collection efforts through proactive account review and patient outreach.
• Ensure patient interactions reflect company values and support a positive patient experience.

• Maintain accurate and complete documentation of all account research, patient interactions, and account…