Patient Account Representative - Physician Claims

Guidehouse Careers; San Antonio (TX); Hybrid; USD 34,000 - 56,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Holidays & PTO

401(k) Plan

Life Insurance

HSAs/FSAs

Disability Insurance

Tuition Reimbursement

Job summary

Guidehouse is seeking a Patient Account Representative (PAR) – Physician Claims on a hybrid schedule (2 days in office, 3 days remote). The role focuses on billing processes, payer follow-up, account resolution and scanning as needed.

You will work with multiple departments to meet facility goals and ensure accurate remittance processing. The PAR handles CMS-1500 physician claims, follows up on denials, reviews remittance advice, and submits appeals when appropriate.

Qualifications

• High School Diploma / GED or 3 years relevant equivalent experience.
• 0-2+ years experience in office, business, operations, customer service or healthcare field.

Responsibilities

• Emphasis working Physician Claims CMS-1500's
• Contacts third party payers and guarantors via payer websites or by phone to resolve balances
• Work all correspondence within 24 hours of receipt
• Denials: take actions to obtain account resolution
• Submit appeals for non-clinical denials
• Monitor denials for trends and report findings to supervisor
• Bills or re-bills claims as necessary
• Ensure compliance with billing/HIPAA rules
• Document each account worked in the client system
• Update patient accounts with corrected information
• Post adjustments per SOPs or leadership directions
• Handle internal/external calls professionally

Skills

Customer service

Office software

Communication

Education

High School Diploma / GED

3 years relevant experience

Tools

Word

Excel

Job description

Job Family : Patient Account Representative

Travel Required : None

Clearance Required : None

What You Will Do :

The Patient Account Representative (PAR) - Physician Claims is expected to perform specific billing processes, follow-up, account resolution, adjustments and scanning as required. This position works with other departments to facilitate the meeting of both departmental facility goals and objectives. This position is responsible for account resolution. Ability to find solutions to problems and keeping management informed of patterns regarding payments and or other issues with specific payers is essential

This position will be on a hybrid schedule working two days in office and three days from home. Company office locations pertaining to this opening include El Segundo, CA, Lewisville, TX and San Antonio, TX.

The Patient Account Representative has an extensive knowledge of billing, accounts receivable follow-up, timely filing guidelines and the ability to effectively review remittance advices and electronic billing reports from payer to determine the action required. This position performs all related job duties as assigned.

Duties and Responsibilities

• Emphasis working Physician Claims CMS-1500's
• Contacts third party payers and guarantors via payer websites or by phone to resolve account balances on all assigned accounts.
• Work all correspondence within 24 hours or receipt. Detail notes regarding correspondence must be entered into the client's system
• Works all denials taking necessary actions to obtain account resolution
• Submits appeals, as appropriate, for all non-clinical denials
• Monitors all denials for trends and issues and reports findings to supervisor
• Bills or re-bills claims as necessary
• Ensures the client follows all state and federal rules and regulations both billing and HIPAA
• Completes assigned special projects within the time frames given
• Attend training sessions and seminars offered by the Client and Third-Party Payers.
• Appropriately documents each account worked in client practice management system
• Makes necessary corrections in client practice management system.
• Resolves or forwards all address and / or plan changes as appropriate to ensure the integrity of the insurance master is maintained
• Updates patient accounts with corrected demographic or insurance information
• Posts adjustments based on standard operating procedures or as directed by leadership
• Handles all customer calls both internal and external in a professional and courteous manner.

What You Will Need :

• High School Diploma / GED or 3 years of relevant equivalent experience in lieu of Diploma / GED.
• 0-2+ year's experience in office, business, operations, customer service or healthcare field.

What Would Be Nice To Have :

• Previous experience working with insurance portals.
• Knowledge and utilization of desktop applications to include Word and Excel is essential.
• Ability to initiate and follow through on projects and work independently with minimal supervision

The annual salary range for this position is $34,000.00-$56,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer :

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Opportunity Employer-Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.