Patient Account Representative
$45,510–$64,210 year
HybridSaint Paul, Minnesota, United States
Job Summary
Resolve front-end claim edits to ensure timely clean claim submission to third-party payors and adjudicate outstanding patient accounts to reconcile balances. Follow up on delayed or delinquent processing by clarifying reasons for denials, utilizing payor portals, and filing claim appeals. Process hospital receivables and perform basic maintenance of patient accounts in the EMR system while adhering to commercial and government payor regulatory requirements. This role supports back-end revenue recovery at Gillette Children's, a global beacon of care for pediatric patients with brain, bone, and movement conditions. Candidates must reside in Minnesota or Wisconsin and complete initial on-site training in St. Paul, MN, before transitioning to a remote working arrangement.
Required Qualifications
- High School Diploma/ GED
- 1-3 years' experience in customer service, administrative or healthcare setting
- Ability to work onsite in St. Paul, MN as needed
- Must reside in Minnesota or Wisconsin
- Knowledge of commercial and government payor regulatory requirements
- Knowledge of claim forms – UB04, HCFA 1500, etc.
- Ability to research and resolve claim edits
- Knowledge of and ability to accurately read EOB's
- Knowledge of CARC/RARC codes
- Demonstrates understanding and ability to apply patient account policies and procedures
- Demonstrates competency in organizational systems including: Cerner Revenue Cycle, Change Healthcare, eDOCS, online resources and other relevant technology
- Adheres to all organization and department policies, guidelines, and workflows
- Independently completes annual training as assigned
- Completes self-assessment timely and with contributing comments
- Completes 80% of peer feedback for direct peers
- Knowledge & understanding of medical terminology
- Knowledge & understanding of commercial insurance carriers and standard insurance forms
- Strong computer aptitude including knowledge of Microsoft Office (Word, Excel, Outlook)
- Demonstrated strength in customer service, organization, attention to detail and the ability to work independently
- Demonstrated ability to work and problem solve in a collaborative manner within the department and organization
- Demonstrated ability to multi-task and respond quickly/reprioritize changing needs
- Must be able to lift 50 lbs
Desired Qualifications
- Advanced education (Associate or Bachelors)
- 2+ years of medical billing or coding experience that includes exposure to payor
- DME Billing Experience
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