Patient Account Representative

Prime Healthcare Management Inc; Ontario (CA); On-site; USD 32,000 - 39,000; Full time

Job summary

Prime Healthcare in Ontario, California, seeks a Patient Account Rep I to post payments, reconcile accounts, and manage billing workflows daily. The role requires handling payments, follow-up on authorizations, and knowledge of contracts and payer rules.

Responsibilities include data entry, corrections, and ensuring accurate reimbursements under state and federal guidelines. Strong communication and accounts experience preferred; HS diploma required.

Qualifications

• Ability to multi-task and meet required timelines.
• Analytical, mathematical and problem-solving skills.
• Customer services experience required.
• Effective written and verbal communication skills.
• Experience in accounts payable, accounts receivable or cashier experience preferred.
• Familiar with commercial or government billing requirements and knowledge of insurance, coding, and medical terminology is preferred.
• High School Graduate or GED Equivalent Required.
• Knowledge of basic understanding medical coding and third-party operating procedures and practices.
• Knowledge of multiple insurance billing requirements and 6 mo.-1 year of billing experience required.
• Medical and Insurance terminology essential.

Responsibilities

• Post all incoming payments to patient accounts daily.
• Input and retrieve data from computer systems; reconcile accounts daily.
• Apply payments and adjustments to patient accounts.
• Distribute billing to appropriate personnel; follow up on authorizations and referrals.
• Maintain knowledge of contracts and state Workers’ Compensation fee schedules.
• Handle incoming/outgoing mail pertaining to the hospital and correct mailing errors.
• Analyze payments from insurers to ensure maximum reimbursements and resolve issues with payers.
• Support compliant posting of payments according to California and Federal regulations.

Skills

Multi-tasking

Analytical skills

Customer service

Written and verbal communication

Accounts receivable/payable

Billing knowledge

Medical terminology

Education

High School Diploma or GED

Medical coding knowledge

Billing experience (6 months to 1 year)

Job description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Responsibilities

The Patient Account Rep I is responsible for posting all incoming payments to correct patient accounts on a daily basis. Inputs and retrieves data from computer systems. Reconciles accounts daily. Applies payments to patient accounts accurately and efficiently. Distribution of all billing to appropriate personnel. Reviews and performs follow-up on all authorizations, and specialty referrals. Maintains a current knowledge of contracts and state Worker’s Compensation fee schedules. Responsible for the handling of incoming and outgoing mail pertaining to the hospital. Needs to have ability to recognize and correct mailing errors immediately. Always uses proper tact and discretion in handling inquiries from patients and their families. The Patient Account Rep I is responsible for accurate and timely payment analysis of managed care contracts to determine that appropriate reimbursement is received. Utilizing many complex and varying regulations, guidelines and systems, analyzes payments received from insurance companies to assure maximum and correct reimbursement of Hospital’s receivables. Proactively works with payers and in-house resources to identify and resolve issues that hinder optimal and correct account payment. Utilizes and applies the appropriate California and Federal regulations in order to assure compliance in payment practices. Responsible for posting all incoming payments to correct patient accounts on a daily basis. Inputs and retrieves data from computer systems. Reconciles accounts daily. Applies payments to patient accounts accurately and efficiently. Applies contractual adjustments to patient AR balances as needed. Manage and forward underpayments /denials to the appropriate departments for follow-up and further revenue collection as needed.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

• Ability to multi-task, prioritize needs to meet required timelines
• Analytical, mathematical and problem-solving skills required
• Customer Services experience required
• Effective written and verbal communication skills
• Experience in accounts payable, accounts receivable or cashier experience preferred
• Familiar with commercial or government billing requirements and knowledge of insurance, coding, and medical terminology is preferred
• High School Graduate or GED Equivalent Required
• Knowledge of basic understanding medical coding and third-party operating procedures and practices
• Knowledge of multiple insurance billing requirements and 6 mo.-1 year of billing experience required
• Medical and Insurance terminology essential

Pay Transparency

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $23.12 to $28.00. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf