Under the direction of the Revenue Cycle Manager and Supervisor, the Patient Account Representative monitors insurance claims with no response, pending response, denial, and appeal status, and works to resolve balances billed to insurance carriers through accurate claim adjudication.
The role also evaluates and resolves underpayments, overpayments, and refund requests from insurance carriers. The position is primarily remote, but occasional work in a normal office environment and travel to hospitals or other work locations may be required.
Requirements & Qualifications
Education
- High school diploma or GED required
- Associate's degree preferred
Experience
- 3 to 5 years of relevant experience in Revenue Cycle and/or Epic Revenue Cycle applications
- Minimum 6 months of experience in one or more of the following:
- Medical claim follow-up
- Resolving credit balances
- Performing electronic or manual cash posting
- Preferred: 12 months of experience in medical claim follow-up
- Experience with EPIC Resolute billing system, claim clearinghouses, and payer websites such as Waystar and Availity preferred
Knowledge
- Understanding of the healthcare revenue cycle from intake to final payment
- Familiarity with CMS-1500 claim forms and basic coding requirements
- Understanding of payer adjudication concepts and coordination of benefits
- Ability to read and interpret Explanation of Benefits and Remittance Advice/claim adjustment reason codes
- Ability to use payer portals and claims clearinghouses
- Prior use of claims operating systems such as Epic, Athena, NextGen, or Meditech
- Understanding of common billing and insurance acronyms
Skills
- Strong communication and organizational skills
- Ability to self-manage in a work-from-home environment
- Excellent analytical and problem-solving skills
- Ability to prioritize workload accurately and efficiently
- Attention to detail and strong documentation skills
- Ability to work under pressure and adapt to changing payer rules
- Professional phone and email etiquette
Location
Cincinnati, Ohio, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
3 weeks ago