Patient Account Representative - Medicare, Medicaid, Commercial Claims

Job Family:

Travel Required:

Clearance Required:

What You Will Do:  

The Insurance Patient Account Representative is an extension of a client’s business office staff. Representatives are responsible for taking in-coming and making out-going calls to patients and insurance companies to resolve account balances. All client policies and procedures are followed. Representatives will perform any and all job-related duties as assigned.

Essential Job Functions

• Facilitates the billing and collection processes of outstanding accounts receivable

• Communicates with internal and external contacts to explain primary, secondary and tertiary billing, collection and resolution of claims including Medicare and other government and nongovernment accounts

• Monitors daily queues for customer services/quality and productivity to maintain acceptable level as established by the departments; alerts management of high call volume patterns

• Handles incoming and outgoing billing correspondence and phone inquiries relating to patient, third party administrators, attorneys, vendors and other insurance payers

• Documents conversations and/or actions taken to support all claims inquiries, review and/or reconsiderations; streamlines the follow-up process of team members assisting on the file

• Analyzes claims to determine compliant and accurate coding, charging; reviews file to confirm demographic and billing information is updated

• Works to resolve any claim or billing concerns and takes appropriate action to escalate issues to management when appropriate

• Performs follow-up processes on accounts to work towards a zero balance

• Files a timely reconsideration or review of claim with supporting documentation such as a corrected claim, medical records and letter of explanation as necessary; communicates with departments to gather information needed to resolve the claim

• Performs balance transfers

• UB-04 & CMS 1500

• Complete all business-related requests and correspondence from patients and insurance companies.

• Responsible for working on average 35 Accounts Per Day

• Complete all assigned projects in a timely manner. 

• Assist client and patients in all requested tasks.

• Communicate to Guidehouse management areas of concern or areas of improvement. 

• Research and respond to all patient inquiries received by telephone and mail.

• Update patient demographic information and initiate account adjustments.

• Try to resolve account balances to zero prior to accounts being forwarded to an outside agency for collections.

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 in insurance portals

• PC skills in a Windows environment.

• 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

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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.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [email protected].  Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.  Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [email protected]. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.