Patient Account Representative

St. Joseph’s/Candler Health System; Savannah (GA); Hybrid; USD 42,000 - 64,000; Full time

Job summary

St. Joseph’s/Candler Health System in Savannah is seeking a Patient Accounts Representative to prepare and submit insurance claims, manage electronic and paper submissions, and ensure compliance with federal and state regulations.

The role requires follow-up on adjudication, denial resolution, and coordination with payors to maximize timely payments; 2–3 years of medical billing and customer service experience preferred.

Qualifications

• Experience in medical accounts or hospital billing preferred.
• Customer service experience preferred.
• High school diploma preferred.

Responsibilities

• Resolves payer denials promptly and re-bills accounts when necessary.
• Responds to reminders promptly and documents all action taken.
• Files claims, follows up on secondary aged accounts, resolves reminders.
• Submits claims through Meditech and Clearinghouse; reviews Aging Report and follows up with payors.
• Performs daily billing tasks: electronic claims, paper claims, pre-authorizations.
• Keeps up to date on billing/compliance rules and seeks needed assistance.

Skills

Medical accounts experience

Hospital experience

Customer service experience

Education

High School Diploma

Job description

The Patient Accounts Representative is responsible to prepare and submits claims to various insurance companies either electronically or by paper. They will need to ensure that all insurance claim edits from Meditech and Cirius are reviewed, analyzed and resolved. Ensure that the claims are compliant with federal and state regulations. Patient Account Representative is responsible for ensuring that all insurance claims are processed and paid. They will perform all follow up activity on the claim until adjudication. Responsibilities include but are not limited to billing, prompt follow-up and understands the laws that govern the billing.

Education

High School Diploma - Preferred

Experience

2-3 Years Medical Accounts or Hospital experience - Preferred

2-3 Years Customer Service experience - Preferred

License & Certification

None Required

Core Job Functions

• Resolves payer denials promptly and appropriately. Mails paper claims promptly to the proper address. Re-bills accounts when necessary.
• Acts upon computer reminders promptly and appropriately. Uses the most effective follow up method needed. Documents all action taken.
• Files claims as assigned. Follows up on secondary aged accounts according to established time parameters. Resolves reminders promptly.
• Submits assigned claims through Meditech and Billing Clearinghouse and provides confirmation reports to the manager. Reviews the Accounts Receivable Aging Report and works outstanding claims, oldest to newest, making calls to appropriate payor to determine claim status. Works with payor on resolving claim disputes, submits requested paperwork, and notifies Appeals Group for all denials.
• Daily performs billing functions to include but not limited to review and verification of electronic claims, transmission of claims to clearing house, preparation of paper claims as needed, preparation of secondary claims, processing of overpayment and underpayment responses and payment posting as assigned. Review treatment authorization status and obtain pre-authorization as needed. Coordinate and review upcoming appointments with operations assistant to assure pre-authorizations for provider visits.
• Seeks answers/assistance from the appropriate source. Keeps up to date on billing/compliance rule changes.