Patient Account Representative - Professional Billing

The Patient Account Representative works in the Luminis Health Clinical Enterprise Professional Business Office (PBO) providing professional and facility billing services within the Revenue Cycle. The incumbent manages the claims process, including accurate and timely charge review, claim creation, submission, and appropriate follow-up with insurance companies and patients. The Patient Account Representative provides outstanding service to both internal and external stakeholders, assisting in process improvements and inquiries, ensuring payments are appropriately recorded and adjudicated timely to maximize revenue.

1. Practice Management & Systems Operations

Demonstrates proficient utilization of billing systems (e.g., Epic EHR) to update patient demographic and facility file information, manage pre-AR and post-AR charge sessions, and resolve billing workqueues. Appropriately edits claims and documents account actions using standard claim notes and system workflows. Utilizes clearinghouse portals, banking solutions, and ERA/EOB electronic tools to facilitate account resolution.

2. Claims Submission & Payer Follow-Up

Demonstrates a solid understanding of the end-to-end revenue cycle. Prepares, audits, and submits clean primary and secondary claims electronically or on paper according to payer specifications. Performs diligent third-party insurance follow-up on outstanding claims, resolving complex reimbursement barriers that adversely affect timely payment.

3. Denial & Rejection Management

Analyzes insurance rejections and remittance denials to execute denial workflows. Performs root-cause analysis on recurring denial patterns and collaborates with cross-functional teams to resolve system, credentialing, or payer issues. Maintains accurate tracking, filing, and account documentation for all collections and follow-up activities.

4. Patient Services & Customer Care

Responds to patient and customer billing inquiries professionally and promptly via phone, written correspondence, or virtual communication tools. Facilitates resolution of financial balances, sets up approved payment arrangements, and explains financial assistance policies while strictly maintaining HIPAA and protected health information (PHI) privacy standards.

5. Business Conduct & Workplace Efficiency

Demonstrates proficiency with Microsoft Office applications (Word, Excel, Outlook) and core communication platforms. Displays professionalism, adaptability, and a collaborative team attitude. Maintains high dependability, adherence to schedules, and consistent productivity in a deadline-driven, results-oriented environment.

·       Education: High school diploma or GED required.

·       Experience: Two to four years of multi-specialty billing experience preferred, including ICD-10, CPT, and HCPCS coding and medical terminology or related experience. Proven ability to work effectively in an environment with firm deadlines and results-oriented targets.

·       Systems & Technical Skills: Experience in Epic EHR preferred. Experience operating multi-line phone systems and standard office equipment. Proficient in Microsoft Office (Word, Excel, Outlook) and comfortable communicating professionally via internet and virtual collaboration tools.

·       None required.

·       Blood-Borne Pathogens: There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.

·       Physical Demands: The physical demands and work environment described are representative of those an employee encounters while performing essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions in accordance with the Americans with Disabilities Act (ADA).