Patient Account Representative II

Description

The Patient Accounts Specialist is responsible for managing and maintaining assigned patient accounts to ensure timely and accurate reimbursement for Pinehurst Surgical Clinic. This role involves working with internal and external customers to resolve unpaid insurance claims and patient balances through appropriate follow-up and adherence to the clinic’s “Flawless Reimbursement” system. This position’s top priority is to maximize reimbursement and confirm that all insurance carriers have paid accurately and in accordance with contractual and non-contractual agreements.

Essential Duties and Responsibilities

· Process patient payments, adjustments, and refunds accurately and in a timely manner.

· Identify and correct medical coding errors, data entry mistakes, and payment discrepancies, including underpayments or overpayments.

· Respond to patient inquiries regarding billing discrepancies, unsettled balances, and reimbursements with professionalism and clarity.

· Communicate with patients by phone, email, and written correspondence regarding overdue balances and accounts pending collection.

· Verify and ensure proper insurance payments; research and resolve any payment errors or denials.

· Work on the prepay list to appropriately apply funds from prepayment to outstanding claims.

· Utilize insurance portals, including Blue E, Medicare, UnitedHealthcare, and other payor systems, to manage and track claims.

· Support additional billing and collection responsibilities as needed to meet departmental goals.

Requirements

 Preferred Qualifications

· 1–3 years of experience in medical billing or patient account management preferred.

· Associate degree or coursework in business, healthcare administration, or related field preferred.

· Knowledge and understanding of insurance plans, managed care contracts, and reimbursement processes.

· Familiarity with billing and payment procedures, including rules and regulations for both contractual and non-contractual carriers.

· Demonstrated ability to remain calm and professional in a fast-paced, high-volume environment.

· Strong communication skills with a clear, courteous, and professional demeanor.

· Ability to read, comprehend, and follow detailed oral and written instructions.

· Quick learner with the ability to adapt to new systems and processes efficiently.

Personal Characteristics

· Exceptional verbal and written communication skills.

· Excellent analytical and problem-solving abilities.

· Strong time management and organizational skills.

· Detail-oriented with high accuracy.

· Dedicated to providing outstanding customer service.