Account Representative

Key Responsibilities

• Prepare, review, and submit compliant medical claims through approved billing and electronic data interchange systems.
• Verify accuracy of patient demographics, insurance information, coding, and supporting documentation prior to claim submission.
• Collaborate with internal departments to obtain missing or corrected information required for claim completion.
• Monitor the status of submitted claims, identify delays, and resolve issues that impact timely reimbursement.
• Review and correct denied or rejected claims, ensuring resubmission within payer timelines and regulatory requirements.
• Maintain comprehensive documentation of billing activities, communications, and follow up actions within the billing system.
• Recognize patterns in payer denials, documentation deficiencies, or workflow issues and notify appropriate leadership.
• Assist with internal audits and quality improvement initiatives related to billing accuracy and compliance.
• Maintain current knowledge of billing regulations, payer requirements, and updates to coding and documentation standards.