Patient Accounts Representative - Hybrid Remote

Patient Account Representative Overview of Responsibilities: Using established protocols, monitor, research and update patient accounts to reconcile and maximize reimbursement. Answers patient, insurance calls and correspondence resolving questions in a time frame that meets or exceeds department standards.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Essential Functions:

• Researches and resolves rejected, incorrectly paid and denied claims in assigned work-files within an established time frame. Verify claims and cash files are being sent and received and ensure accurate payment posting is applied to patient accounts from both patients and insurance carriers.
• Researches and resolves unpaid claims on work files as assigned by supervisor.
• Responds professionally to all inquiries from patients, Pacific Medical Centers’ staff or payers regarding billing and/or payment questions in a timely fashion. Coordinates information on behalf of patients, providers and business office personnel to respond to inquiries regarding claim billing or insurance Explanation of Benefits and third-party liability claims.
• Contacts payers to identify reason for payment discrepancies. This may include verifying insurance coverage and benefits, obtaining required authorizations and referrals for hospital admissions and surgery procedures or following up with clinics that are responsible to obtain the missing information.
• Verifies that all charges within a patient’s account have been billed to the patient’s correct insurance plan. Contacts payer by telephone or written letter to pursue insurance payment.
• Maintains payer billing and payment information on all special contracts and keeps unit supervisor and department Director, Business Services informed of changes in billing requirements, rejection or denial codes as they pertain to claim processing and coding.
• Provides comprehensive management of accounts receivable functions from point of service through resolution of outstanding balances.
• Communicates and provides guidance to clinic business office personnel regarding insurance carrier contractual and regulatory requirements.
• Ensures Pacific Medical Center’s billing, collection and cash posting activities comply with corporate, federal and state fraud and abuse control programs.
• Receives, documents, researches, and responds to all account inquiries from patients, health plans, attorneys, and other Pacific Medical Centers departments and clinic personnel in verbal or written communication.
• Initiates contact with physicians, providers, collection agencies, health plans, attorneys, or other Pacific Medical Centers departments relevant to resolution of account inquiry.
• Provides answers to reimbursement questions from medical and support staff regarding health-plans eligibility, benefit issues, copay requirements, and medical referral requirements.
• Monitors patient account data when interacting with patients to ensure that accurate information regarding patient’s address, phone number and insurance is correctly reflected on the patient’s account.
• Researches and resolves information on unpaid accounts receivable reports and makes any corrections necessary to ensure maximum reimbursement for all Pacific Medical Centers services.
• Identifies past due accounts and submits them to the Unit Lead for assignment to outside collection agency.
• Maintains current knowledge of medical terminology, diagnosis, coding, claim processing guidelines, Financial Classification Status (FSC), Charity Care Program and collection policies.
• Establishes payment arrangements for patients on past due account and submit them to the Unit Lead for approval.
• According to established protocols, monitor, research, post payments and update patient accounts to reconcile and maximize reimbursement.

Required qualifications:

• 1 year of functional experience using Microsoft Office products (Word, Excel).

Preferred qualifications:

• Associate's Degree in a business-related field.
• Upon hire: CRCR Certification
• 1 year of experience in either physician/hospital billing or other healthcare business setting.
• 3 months of Successful customer service experience with patients and insurers.
• 1 year of Collection experience.
• 1 year of experience using EPIC, payspan and insurance portals

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our mission to advocate, educate and provide extraordinary care.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.