The Healthcare Patient Account Representative is responsible for managing patient accounts, billing, and collections. This role involves interacting with patients to resolve billing inquiries, process payments, and ensure accurate and timely billing submissions. The ideal candidate will have strong analytical skills, attention to detail, and excellent communication abilities to provide outstanding customer service while adhering to healthcare regulations and policies.

Key Responsibilities:

1. Billing and Claims Processing:
   • Review billing codes, patient demographics, and insurance information for accuracy.
   • Ensure timely and accurate data collection and entry of insurance/payer information into the electronic medical record to support submission of insurance claims to third-party payers.
   • Educate patients on unpaid patient balances and attempt to collect payment.
   • Register, load and process insurance eligibility for each patient prior to the patient's appointment.
   • Review patient benefits prior to in-office injections/procedures being performed, and assist in the authorization and pre-certification process.
   • Review schedule in advance and determine co-pays/co-insurance to be collected at the point of service.
2. Patient Account Management:
   • Maintain patient accounts, including posting charges, payments, and adjustments.
   • Review patient account balances and contact patients regarding outstanding balances or payment arrangements.
   • Assist patients with billing inquiries, insurance coverage questions, and payment options.
3. Payment Processing:
   • Process payments, refunds, and adjustments accurately using billing software.
   • Reconcile daily deposits and prepare bank deposits as necessary.
   • Correct inaccurate insurance loads to ensure timely filing and payment of claims.
4. Customer Service:
   • Provide excellent customer service to patients, insurance companies, and other stakeholders.
   • Address patient concerns, complaints, and inquiries in a professional and empathetic manner.
   • Educate patients on billing processes, insurance benefits, and financial assistance programs.
5. Documentation and Reporting:
   • Maintain accurate and detailed records of all account activities and communications.
   • Generate reports on billing, collections, and account receivables for management review.
   • Assist in identifying trends, issues, and areas for improvement in revenue cycle processes.
6. Compliance and Regulations:
   • Adhere to healthcare regulations, compliance standards, and billing guidelines.
   • Stay updated on changes in healthcare laws, insurance regulations, and coding practices.
   • Ensure patient confidentiality and data security in accordance with HIPAA regulations.

Qualifications:

• High School Diploma or equivalent; Associate's or Bachelor's degree preferred.
• Previous experience in healthcare billing, collections, or revenue cycle management.
• Knowledge of medical billing codes (CPT, ICD-10), insurance claims processing, and healthcare reimbursement methodologies.
• Proficiency in using billing software, electronic health record (EHR) systems, and Microsoft Office Suite.
• Strong analytical, problem-solving, and organizational skills.
• Excellent communication and interpersonal abilities.