Patient Accounts Representative

Pueblo Community Health Center, Inc.; Pueblo (CO); On-site; USD 52,149,048 - 61,319,731; Full time

Job summary

Pueblo Community Health Center, Inc. is seeking a Patient Accounts Representative to submit claims, analyze payer denials, and resolve unpaid claims, while posting payments accurately and timely.

The role reports to the Patient Accounts Manager and requires a high school diploma or equivalent, one year of medical billing experience, familiarity with Medicaid/Medicare and third‑party payers, plus a valid driver’s license.

Qualifications

• High School Diploma or equivalent required.
• One year medical billing experience required.
• Experience with Medicaid, Medicare, HMOs/POs and/or other third party payers.
• Valid driver’s license and auto insurance as required by law.

Responsibilities

• Submit daily electronic claims and paper claims to clearinghouse and insurance payers.
• File all applicable insurance forms for Center’s patients.
• Process appeals, refund requests and inquiries; make necessary adjustments to accounts to comply with programs and carriers.
• Analyze account balances to accurately bill patients for balance due.
• Assist patients with billing questions.
• Review insurance aging reports to identify unpaid claims for resolution.
• Arrange payment schedules with patients for past due accounts.
• Inform Patient Account Manager of any noncompliance issues.
• Assist in training of new Patient Accounts Representatives and participate in cross training.
• Participate in department and General Staff Meetings.
• Work outstanding tasks for encounter resolution in practice management system.
• Make inquiries via telephone or payer websites on patient encounters for payment resolution.

Education

High School Diploma or equivalent

Job description

Starting Pay Range $18.19 – 21.40, per hour and considers experience

Job Summary

The Patient Accounts Representative Responsible for submitting claims, analyzing payer denials and problem solving to resolve unpaid claims. Responsible for posting payments from payers accurately and timely.

Reports to

Patient Accounts Manager

Supervision Exercised

None

Education / Experience / License / Certification

• High School Degree or equivalent
• One year medical billing experience required
• Experience with Medicaid, Medicare, HMO/PPO’s, and/or other Third Party Payers
• Valid driver’s license and auto insurance as required by law.

Required Travel

Occasional local travel may be required.

Knowledge / Skills / Abilities

The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• A working knowledge of CPT and ICD-10-CM coding helpful.
• A working knowledge of insurance billing.
• Essential to have ability to understand verbal information/instruction, to exchange verbal information with others and to present information verbally.
• Essential to have ability to read and understand written materials, and ability to compose information/instruction in written form.
• Essential to be able to reason mathematically, to have analytical and problem solving skills.
• Ability to speak Spanish helpful.

Essential Duties and Responsibilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ensure the function and activities of this department to embrace the philosophy, mission, values and Communicate with Heart service model supported by the Board of Directors of Pueblo Community Health Center, Inc.
2. Adhere to the guidelines and procedures of Pueblo Community Health Center, Inc.
3. Responsible for submitting daily electronic claims and paper claims to clearinghouse and insurance payers.
4. File all applicable insurance forms for Center’s patients.
5. Process appeals, refund requestsand inquiries. Make any necessary adjustments to accounts in order to comply with PCHC programs and insurance carriers.
6. Analyze account balances to accurately bill patients for balance due
7. Assist patients with billing questions.
8. Review insurance aging reports to identify unpaid claims for resolution.
9. Arrange payment schedules with patients for collection of past due accounts.
10. Inform Patient Account Manager of any noncompliance issues.
11. Assist in training of new Patient Accounts Representatives and participate in cross training as directed by the Patient Account Manager.
12. Participate in department and General Staff Meetings.
13. Work outstanding tasks for encounter resolution in practice management system.
14. Make inquires via telephone or payer website on patient encounters for payment resolution.
15. Perform other related duties as assigned.

The above duties are not all inclusive and are not intended to limit or define the duties that may be assigned.

Physical Demands

The physical demands described here are representative of those that are typically required to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The employee frequently communicates with employees and the public and must be able to exchange accurate information while performing patient care tasks and routine office tasks.
• The employee occasionally retrieves and disseminates information using written materials and electronic devices.
• The employee frequently observes, receives and otherwise obtains information from all relevant sources and identifies information by categorizing, recognizing differences or similarities, and detecting changes in circumstances or events.
• The employee frequently utilizes dental equipment requiring manual dexterity with both hands and fingers in order to maintain dental and basic lab activities in a dental clinic.
• The employee occasionally operates computers and other office productivity equipment.
• The employee occasionally remains in a stationary position while performing patient care tasks and routine office tasks.
• The employee frequently moves about the office; and positions self while performing patient care tasks and routine office duties such as accessing files and operating equipment.
• The employee frequently moves or positions objects weighing up to 25 pounds and occasionally up to 50 pounds while performing routine office duties such as opening file drawers, moving patient files, etc.

Pueblo Community Health Center is a tobacco-free workplace. EOE