Patient Account Representative (2026-0514)

About the Role

This position is responsible for performing a variety of complex duties in support of reimbursement from patient liability and insurance carriers for both hospital and professional claim adjudication. As a Patient Account Representative, you will manage the entire account lifecycle—processing claims, collecting payments, resolving issues, and addressing patient inquiries with empathy and clarity. The role requires substantial knowledge and execution of third-party payer policies, experience in patient liability management, collections, and strong communication proficiency.

Responsibilities

• Maintain knowledge of payer requirements as part of Valley Medical Center’s Corporate Compliance program.
• Familiarize with VMC Patient Accounts payment policies and procedures, including financial assistance programs.
• Request financial assistance adjustments, administrative adjustments, and contractual allowance corrections per policy.
• Work with patients on self-pay account balances, payment arrangements, and referrals to financial counselors when appropriate.
• Handle inbound and outbound calls to resolve questions from patients, families, insurance companies, attorneys, or other entities.
• Ensure accurate and timely billing of UB/HCFA claims for all insurance/government payors, including primary, secondary, and tertiary billing.
• Adhere to federal, state, and local payer-billing requirements.
• Utilize payer/provider manuals, bulletins, and hospital policies to submit "clean" claims.
• Review payer rejections (837 transaction sets), correct errors, and resubmit claims.
• Analyze Explanation of Benefits (EOBs) and vouchers to pursue claim payments.
• Edit patient insurance information in accordance with the Insurance Carrier Change Policy and Procedure.
• Contact insurance companies, patients, physicians, or staff to obtain missing information or collect outstanding payments.
• Follow up with payers for claim status and resolve payment barriers.
• Research and resolve underpaid claims in collaboration with the contracting department.
• Research and appeal denied claims to secure payment.
• Process patient payments by phone or in person.
• Explain policies and procedures to customers and resolve problems independently or as part of a team.
• Reconcile daily cash and process department deposits within 24 hours.
• Coordinate non-compliant or disputed denials with the Clinical Audit & Appeals Manager.
• Respond to requests for information or documentation to expedite claim payments.
• Escalate problem accounts to the Manager when necessary.
• Maintain confidentiality of protected health information.
• Return all phone calls within 24 hours of receipt.
• Document daily activities for productivity tracking and account volume management.
• Participate in meetings and training as required.
• Notify leadership of new insurance regulations.

Requirements

• Associate degree (2-year) required or equivalent experience; bachelor’s degree preferred.
• Minimum three years of experience in a hospital, medical office/clinic business office, or insurance company, with billing and collections experience.
• Comprehensive knowledge of third-party insurance processes, patient collection processing, and complex remittance processing.
• Demonstrated knowledge of medical terminology and abbreviations.
• Proficiency in Microsoft Word, Excel, and Outlook.

Qualifications

• Prior Epic Resolute Hospital and Professional experience preferred.
• Excellent organizational and time management skills.
• Strong written and verbal communication skills.
• Intermediate technical skills, including PC and MS Outlook.
• Advanced knowledge of Explanation of Benefits (EOB) for UB-04 (Hospital Billing) and HCFA 1500 (Professional Billing).
• Advanced knowledge of insurance billing, collections, and terminology.
• Extensive knowledge of third-party reimbursements from commercial insurers, government payers, and specialty payers.
• Ability to adapt to change and communicate effectively with a diverse population.
• Demonstrated ability to communicate with tact, poise, courtesy, respect, and compassion.
• Strong prioritization skills and ability to work independently or within a team.
• Commitment to organizational values and professional conduct.

Pay

Salary range: $24.92–$41.65 per hour, based on experience.

Schedule

Full-time, 8:00 AM to 5:00 PM, Monday through Friday (or as assigned).