Patient Account Representative (70329)

Department: Billing

Position: Patient Account Representative

Employee Category: Non-Exempt

Reporting Relationship: Manager of Revenue Cycle Management

Direct Reports: None

None Work Environment: Office-Based

Company Values:

• Teamwork- Collaborates effectively with coworkers and stakeholders to achieve shared goals.
• Belonging- Creates an environment where all individuals feel respected, valued, and included.
• Compassion- Demonstrates empathy and understanding when interacting with others.
• Resilience- Maintains effectiveness and professionalism during challenges and change.
• Stewardship- Uses organizational resources responsibly and acts in the organization's best interest.
• Quality- Consistently delivers accurate and reliable work.
• Value- Improves organizational outcomes through efficiency and continuous improvement.

Summary of Duties and Responsibilities:

The Patient Account Representative is responsible for managing self-pay patient accounts by ensuring account accuracy, reviewing financial documentation, applying financial assistance programs, and assisting patients in resolving outstanding balances. This position supports accurate patient billing while helping eligible patients access available financial assistance and payment options.

The Patient Account Representative serves as a primary point of contact for patients regarding self-pay accounts and collaborates with Revenue Cycle staff to improve collections, reduce self-pay accounts receivable, and provide an exceptional patient financial experience

Essential Duties and Responsibilities

Patient Account Management

• Review self-pay encounters for accuracy prior to generating patient statements.
• Review documentation to ensure appropriate discounts are applied, including verification of Sliding Fee Scale applications and proof of income.
• Make billing corrections and account adjustments to ensure accurate patient balances and timely reimbursement.
• Validate patient financial information and maintain accurate self-pay account records.
• Request, collect, scan, and upload documentation required to support patient financial assistance and account processing.
• Review patient accounts to ensure compliance with organizational financial assistance policies.

Customer Service and Financial Assistance

• Respond to patient inquiries regarding account balances, insurance benefits, deductibles, copayments, and financial responsibilities.
• Educate patients regarding available financial assistance programs and eligibility requirements.
• Assist patients in completing financial assistance applications and collecting required documentation.
• Coordinate payment arrangements with Patient Account Resolution Specialists.
• Answer incoming phone calls related to patient billing, balances, payment plans, and financial assistance.
• Provide professional and compassionate customer service while resolving patient account concerns.

Billing Support and Collaboration

• Coordinate with Claims Resolution Specialists and Coders to investigate denied claims, credit balances, and account discrepancies.
• Assist front office staff with patient billing and eligibility questions.
• Monitor self-pay account activity and identify trends or recurring issues affecting reimbursement.
• Track and communicate ongoing billing issues and process improvement opportunities to the Patient Account Manager and Director of Revenue Cycle Management.
• Maintain current knowledge of organizational financial assistance programs, billing policies, and payer requirements

Documentation and Compliance

• Maintain complete, accurate, and timely documentation within the electronic medical record and billing systems.
• Protect patient confidentiality and ensure compliance with HIPAA and organizational policies.
• Maintain compliance with Medicare, Medicaid, and organizational billing requirements.
• Participate in quality improvement initiatives, departmental meetings, and special projects.

General Expectations

• Meet established productivity, quality, and timeliness expectations.
• Support organizational initiatives that improve patient access, patient satisfaction, and financial performance.
• Perform other duties as assigned.

Success Indicators / Key Performance Metrics

• Self-pay Accounts Receivable (AR)
• Self-pay AR Days
• Collections for self-pay accounts
• Collections for special programs
• Accuracy of Sliding Fee Scale documentation
• Timeliness of account processing

Top performers consistently demonstrate initiative in resolving patient account issues, maintain accurate documentation, maximize reimbursement opportunities, provide excellent customer service, and collaborate effectively with the Revenue Cycle team.