PATIENT ACCOUNTS REPRESENTATIVE

Charles River Community Health; Boston (MA); Hybrid; USD 30,000 - 40,000; Full time

Benefits offered by this job

Medical, Vision & Dental Insurance

Disability & Life Insurance

Generous Paid Time Off

Flexible Spending Account

Job summary

Charles River Community Health seeks a Patient Accounts Representative to manage charge review, payment posting, denials, and patient billing using Epic Revenue Cycle. You will reconcile accounts, monitor AR, and resolve issues across departments to ensure accurate and timely billing.

The role requires 3+ years of medical billing experience, proficiency with Word/Excel, and strong collaboration skills to support equitable patient care in our community.

Qualifications

• Three years of medical billing experience, preferably in a multi-service FQHC environment.
• Understanding of the third party billing cycle and payer reimbursement rules, methodologies, and adjudication systems.
• Experience with denial management, payment posting, charge reconciliation, reimbursement review, accounts receivable follow-up, and overpayment processing preferred.
• Demonstrated ability to communicate, collaborate, and problem solve across multiple functional areas and departments.
• Proficient with Word and Excel at least at an intermediate level.

Responsibilities

• Process and reconcile 835 files, reimbursement payments, EOBs, cash receipts, and other payer transactions, ensuring accurate payment posting, claim reconciliation, rejection resolution, and rebilling as necessary.
• Monitor insurance accounts receivable, investigate outstanding claims, and follow up on denials through corrective actions, appeals, rebilling, and other resolution activities.
• Work assigned claims, charge review, denial, and overpayment accounts through Epic Revenue Cycle workqueues.
• Review and resolve claim edits, billing exceptions, reimbursement discrepancies, and denial accounts routed through Epic workqueues.
• Process assigned overpayment, refund, recoupment, and payer adjustment accounts according to organizational and payer guidelines.
• Follow established workflows and productivity standards for the timely resolution of Epic workqueue assignments.
• Understand account adjustments, corrections and write-offs to bad debt, and free care and input same into system.
• Understand the setup of the accounts receivable system in such areas as insurance carriers, claim forms, reimbursement methodologies, payer requirements, and service codes.
• Review and track encounter forms produced from the health center’s electronic record system.
• Review, validate, and post charges within Epic including service codes, fees, insurance billing information, patient copayments, and supporting documentation required for the generation of claims to third-party payers
• Work collaboratively with providers to correct incomplete and/or incorrect service and/or diagnosis codes and ensure electronic record documentation is complete for billing purposes.
• Prepare and process patient bills and third party claims.
• Communicate billing discrepancies and information requests to appropriate parties and respond to patient and staff inquiries regarding billing, payment posting, claims processing, denials, reimbursements, and overpayments.
• Maintain patient confidentiality when discussing information regarding patient bills.
• Work collaboratively with other Health Center staff in meeting JCAHO accreditation and other regulatory and/or funding requirements.
• Perform other departmental support duties such as telephone answering and filing.
• Perform other duties as assigned by Patient Accounts Manager or designee.

Skills

Medical billing experience

Denial management

Payment posting

Communication

Word proficiency

Excel proficiency

Independent work

Education

High school diploma or equivalent

Tools

Epic Revenue Cycle

Practice management software

Job description

Description

CLASSIFICATION/STATUS: Non-Exempt, Full Time, Permanent

IMMEDIATE SUPERVISOR: Patient Accounts Manager

SUPERVISORY RESPONSIBILITIES: None

FLEXIBLE WORK OPTION: Hybrid (4 days on-site, additional remote days based on managerial discretion)

PAY RATE: Band 2 ($22.00 - $29.00/hour)

WHO YOU ARE

YOUR ROLE & IMPACT

As part of a dynamic team at Charles River Community Health (CRCH), a healthcare practice providing comprehensive, integrated, and equitable primary healthcare that matters most to them. The Patient Accounts Representative will play a critical role in the seamless administration of patient accounts. The Patient Accounts Representative is responsible for charge review and reconciliation, payment posting, denial management, overpayment resolution, claims processing, insurance billing, and the timely resolution of accounts assigned through Epic Revenue Cycle workqueues.

YOUR RESPONSIBILITIES

• Process and reconcile 835 files, reimbursement payments, EOBs, cash receipts, and other payer transactions, ensuring accurate payment posting, claim reconciliation, rejection resolution, and rebilling as necessary.
• Monitor insurance accounts receivable, investigate outstanding claims, and follow up on denials through corrective actions, appeals, rebilling, and other resolution activities.
• Work assigned claims, charge review, denial, and overpayment accounts through Epic Revenue Cycle workqueues.
• Review and resolve claim edits, billing exceptions, reimbursement discrepancies, and denial accounts routed through Epic workqueues.
• Process assigned overpayment, refund, recoupment, and payer adjustment accounts according to organizational and payer guidelines.
• Follow established workflows and productivity standards for the timely resolution of Epic workqueue assignments.
• Understand account adjustments, corrections and write-offs to bad debt, and free care and input same into system.
• Understand the setup of the accounts receivable system in such areas as insurance carriers, claim forms, reimbursement methodologies, payer requirements, and service codes. Inform the Patient Accounts Manager of issues or changes needed.
• Review and track encounter forms produced from the health center’s electronic record system.
• Review, validate, and post charges within Epic including service codes, fees, insurance billing information, patient copayments, and supporting documentation required for the generation of claims to third-party payers
• Work collaboratively with providers to correct incomplete and/or incorrect service and/or diagnosis codes and ensure electronic record documentation is complete for billing purposes.
• Prepare and process patient bills and third party claims.
• Communicate billing discrepancies and information requests to appropriate parties and respond to patient and staff inquiries regarding billing, payment posting, claims processing, denials, reimbursements, and overpayments.
• Maintain patient confidentiality when discussing information regarding patient bills.
• Work collaboratively with other Health Center staff in meeting JCAHO accreditation and other regulatory and/or funding requirements.
• Perform other departmental support duties such as telephone answering and filing.
• Perform other duties as assigned by Patient Accounts Manager or designee.

YOUR QUALIFICATIONS, COMPETENCIES, TRAITS

• High School Diploma (or equivalent) or certificate program in third party billing required.
• Three years of medical billing experience, preferably in a multi-service FQHC environment.
• Understanding of the third party billing cycle and third party payer reimbursement rules, methodologies, and adjudication systems.
• Demonstrated understanding of and proficiency with the functionality of practice management and billing software systems/applications.
• Experience working claims, charge review, denial, and overpayment workqueues within Epic Revenue Cycle applications preferred.
• Experience with denial management, payment posting, charge reconciliation, reimbursement review, accounts receivable follow-up, and overpayment processing preferred.
• Demonstrated ability to effectively communicate, collaborate, and problem solve across multiple functional areas and departments.
• Demonstrated ability to work independently to prioritize assignments, exercise sound judgment, and take initiative in resolving billing, claims, denial and reimbursement issues.
• Demonstrated proficiency in using Word and Excel at least at an intermediate level.
• Proven commitment to providing patients with exceptional customer service, with dignity, respect, and compassion.
• Commitment to our mission of reducing cultural, financial, and linguistic barriers to care and eliminating health care disparities for low income and underserved populations in our community.

WHO WE ARE & WHAT WE DO

Charles River Community Health’s mission is to partner with individuals and families so they can thrive and lead healthier lives by delivering the comprehensive, integrated, and equitable primary healthcare that matters most to them.

CRCH is a comprehensive practice providing medical, pharmacy, dental, behavioral health, optical, and vision services to diverse underserved local communities. We serve over 13,500 patients annually, and 90% of those served are low income, while over 70% need services in a language other than English.

We are committed to providing patients with timely access to the right care, at the right place and at the right time, collaborating with other organizations to connect patients with a comprehensive range of services and provide continuity of care, and creating new community partnerships to meet the changing needs of patients and the community.

We value caring for everyone with dignity, respect, and compassion, reducing cultural, financial and other barriers to care, and eliminating health care disparities for our patients. We also advocate for the needs of our patients, the community, and public health causes.

OUR PROMISE

If you are passionate about providing access to quality and compassionate care to the underserved, you will find your career rewarding and impactful. As Patient Accounts Representative, you will be part of a dynamic and fast-paced team with a shared vision to break down barriers in delivering healthcare excellence!

OUR BENEFITS & PERKS

• Medical, Vision & Dental Insurance
• Short & Long-term Disability, and Life Insurance
• Generous Paid Time Off
• Flexible Spending A carr org ach Policy ower Bi

Charles River Community Health is strongly committed to diversity and a workplace environment that respects, appreciates and values employee differences and similarities. By providing and supporting a work culture that fosters and builds upon diversity and its strengths, CRCH will better serve our local communities and continue to provide quality patient care and services. CRCH is an employment at-will organization and an equal opportunity employer committed to maintaining a work and learning environment free from discrimination on the basis of sex, race, color, religion, national origin, pregnancy, gender identity, sexual orientation, marital/civil union status, ancestry, place of birth, age, citizenship status, veteran status, political affiliation, genetic information or disability, as defined and required by state and federal laws. Additionally, CRCH prohibits retaliation against an applicant or employee because he or she has engaged in protected activity under the statutes prohibiting discrimination in the workplace.