Patient Accounts Representative

Harris County ESD 11; Spring (TX); On-site; USD 42,000 - 52,000; Full time

Job summary

Harris County ESD 11 seeks a Patient Accounts Representative to manage the full lifecycle of insurance claims, ensuring accurate billing, timely reimbursement, and clear communication with patients, payers, and internal teams.

Ideal candidates will have 3+ years in medical billing or AR, strong knowledge of ICD-10 and payer policies, and proficiency in Excel and billing systems. This role requires attention to detail in a fast-paced environment.

Qualifications

• High school diploma or GED required.
• 3+ years in medical billing, insurance follow-up, or healthcare AR.
• Knowledge of medical terminology, ICD-10, and claim filing processes.
• Understanding of Medicare, Medicaid, commercial insurance, and ambulance billing policies.
• Experience resolving denied/rejected claims and payer AR.
• Proficient in Microsoft Office (Excel, Word) and billing systems.
• Strong communication, organization, and customer service skills.
• Ability to multi-task and prioritize in a fast-paced environment.
• OIG exclusion to participate in federally funded health care programs.

Responsibilities

• Proactive follow-ups on insurance claims with Medicare, Medicaid, and commercial payers to drive timely resolution.
• Review, analyze, and resolve denied or rejected claims with accurate documentation.
• Contact patients to obtain missing information and update on claim status.
• Maintain detailed, compliant records of claim activity for audit readiness.
• Collaborate with billing, coding, verification, and external vendors to address denials.
• Track payer behavior and escalate issues to leadership for process improvements.
• Assist verification team to confirm patient eligibility and benefits.
• Identify overpayments and prepare refund requests with proper documentation.
• Answer inbound calls from patients, attorneys, and stakeholders about billing.
• Monitor accounts receivable and aging reports per payer-specific procedures.
• Refer complex accounts to the Patient Account Supervisor/Manager.
• Perform other duties as assigned.

Skills

Medical billing

Payer follow-up

Billing software

Excel

Communication

Time management

Attention to detail

OIG compliance

Education

High School Diploma or GED

Job description

Description

SUMMARY:

The Patient Accounts Representative is responsible for managing the full lifecycle of insurance claims, ensuring accurate billing, timely reimbursement, and exceptional communication with patients, payers, and internal departments. This role requires strong analytical skills, attention to detail, and the ability to navigate complex payer requirements across Medicare, Medicaid, and commercial insurance plans.

ESSENTIAL FUNCTIONS:

• Performs proactive follow-ups on insurance claims with Medicare, Medicaid, and commercial payers to drive timely resolution of outstanding balances and reduce aging accounts.
• Reviews, analyzes, and resolves denied or rejected claims by identifying root causes, correcting errors, and submitting accurate documentation to payers.
• Contacts patients to obtain missing information, clarify billing concerns, and provide clear updates on claim status and financial responsibilities.
• Maintains detailed, compliant records of all claim activity, payer interactions, and follow-up actions within internal systems to support audit readiness.
• Partners with billing, coding, verification and external vendors to insure accuracy and address system issues contributing to denials.
• Tracks payer behavior and reimbursement patterns, escalating issues to leadership to support process improvements and revenue protection.
• Assists the verification team as needed to confirm patient eligibility and benefits, preventing avoidable claim delays.
• Identifies overpayments for both patients and insurance carriers, prepares refund requests with proper documentation, and notifies management promptly.
• Answers inbound calls from patients, attorneys, and other stakeholders, providing accurate information and resolving billing-related inquiries.
• Monitors and maintains accounts receivables by processing aging reports and specific workflows as indicated by the collection procedures for each payer type.
• Refers accounts to Patient Account Supervisor/Manager, as needed.
• Performs other duties as assigned.

QUALIFICATIONS:

• High School Diploma or GED equivalent.
• Minimum of three (3) years of experience in medical billing, insurance follow-up, or healthcare accounts receivable.
• Knowledge of medical terminology, ICD-10 coding, and insurance claim filing processes.
• Understanding of Medicare, Medicaid, commercial insurance, and ambulance billing policies and procedures.
• Experience resolving denied or rejected claims and working payer accounts receivable.
• Proficient in Microsoft Office, including Excel and Word, and billing system software.
• Strong communication, organizational, and customer service skills.
• Ability to multi-task, prioritize workload, and work effectively in a fast-paced environment.
• Must have been excluded by the OIG to Participate in Federally Funded Health Care Programs

PHYSICAL REQUIREMENTS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

• Sit for extended periods of time
• Walk, stand, bend, squat, twist and reach
• Simple grasping and fine manipulation
• Extended keyboarding

WORKING CONDITIONS

• Air-conditioned office environment