Patient Account Representative II

This is a fully remote position, open to applicants in California.

📋 Description

• Accurately process patient claims related to insurance balances in a timely manner, adhering to contracts and policies.

• Address unpaid, underpaid, denied, or unresolved patient accounts effectively.

• Respond to requests from payers by supplying medical records or other necessary documentation via mail or payer portals.

• Follow up on outstanding patient accounts in Epic using phone or payer portal communications.

• Tackle claim edits and payer discrepancies, including the pursuit of underpayments.

• Examine and rectify payer rejections and denials, as well as conduct basic appeals.

• Edit and submit both electronic and hardcopy claims to payers.

• Identify potential trends and escalate issues as appropriate.

• Enter payments and related adjustments in Epic.

• Address credit balances and carry out basic charge corrections.

⛳️ Requirements

• A high school diploma or GED equivalent is required.

• A minimum of two (2) years of progressively responsible and directly relevant work experience.

• Ability to meet individual productivity goals and standards on a weekly basis while adhering to planned priorities.

• Maintain professional communication with PFS staff, payers, and patients.

• Follow oral and written instructions accurately, interpreting institutional and other policies effectively.

• Communicate clearly and professionally, both verbally and in writing.

• Uphold confidentiality of sensitive information.

• Perform basic mathematical calculations.

• Plan, prioritize, and meet deadlines efficiently.

• Collaborate effectively with individuals at all organizational levels.

• Familiarity with accounts receivable software systems and medical billing operations is essential.

• Knowledge of medical reimbursement policies, procedures, and terminology is required.

• Understanding of the payer landscape, including Medicare, Medicaid, Workers’ Compensation, Managed Care, and commercial insurance.

• Strong working knowledge of systems and processes.

• Ability to resolve standard inquiries and problems independently, while managing moderately complex tasks that require critical thinking.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive and collaborative work environment.