Patient Account Representative

About the role

Winners Circle Group is a purpose‑driven organization dedicated to healing through connection, compassion, and clinically excellent care. The Patient Account Representative supports revenue cycle operations by preparing, reviewing, submitting, and tracking claims across a multi‑payor billing environment. This role ensures accurate and timely billing to commercial insurance plans, Medicare, Medicaid, managed care organizations, self‑pay accounts, and other payor sources while maintaining compliance with billing guidelines and internal procedures. The position reports to the Director of Revenue Cycle Management (or an assigned revenue cycle leader) and collaborates with intake, authorization, clinical, finance, and administrative teams.

Responsibilities

• Prepare, review, and submit accurate claims through electronic billing systems, clearinghouses, payor portals, and paper processes as needed.
• Support billing across multiple payor types, including commercial insurance, Medicare, Medicaid, and other contracted arrangements.
• Verify billing information for completeness (demographics, coverage, authorizations, service documentation, diagnosis, dates, rates, and supporting records).
• Monitor claim status, rejection reports, clearinghouse edits, and payor portal updates; correct billing issues promptly.
• Follow up on unpaid, denied, rejected, or underpaid claims and escalate recurring issues to the Director of Revenue Cycle or designated leader.
• Assist with denial research, correction, rebilling, reconsideration requests, and appeals by gathering required documentation and payor‑specific information.
• Post payments, adjustments, recoupments, denials, and contractual allowances accurately based on explanation of benefits, electronic remittance advice, payor correspondence, and internal procedures.
• Maintain organized billing records, account notes, correspondence, and supporting documentation in accordance with company standards and retention requirements.
• Coordinate with intake, authorization, clinical, and administrative staff to resolve missing information, service discrepancies, documentation gaps, and authorization‑related billing barriers.
• Review accounts receivable aging and assist with timely follow‑up to reduce outstanding balances and support cash‑flow objectives.
• Support patient accounting activities, including collecting patient co‑pays, discussing account balances with patients professionally, and documenting payment arrangements.
• Assist with account reconciliation by reviewing patient account balances, payments, adjustments, unapplied funds, and outstanding balances.
• Respond professionally to payor, client, and internal billing inquiries while maintaining confidentiality.
• Support month‑end close activities, billing audits, reporting requests, reconciliation projects, and other revenue cycle initiatives as assigned.
• Maintain knowledge of payor rules, billing requirements, timely filing limits, documentation standards, and company procedures.
• Perform all duties in accordance with HIPAA, payer requirements, organizational policies, and applicable federal, state, and local regulations.

Required qualifications

• High school diploma or equivalent required; associate or bachelor's degree in business, healthcare administration, accounting, or a related field preferred.
• 3–5 years of experience in medical billing, healthcare revenue cycle, accounts receivable, payment posting, claims follow‑up, or related administrative billing work preferred.
• Experience with multiple payors, payor portals, clearinghouses, electronic remittance advice, explanation of benefits, and billing software preferred.
• Working knowledge of healthcare billing processes, insurance verification, claim submission, denial follow‑up, payment posting, and accounts receivable practices.
• Basic understanding of CPT, HCPCS, ICD‑10, modifiers, authorization requirements, and medical or behavioral health terminology preferred.
• Experience handling patient payment transactions, including collecting co‑pays and documenting payments.
• Ability to communicate professionally and sensitively with patients regarding account balances, payment expectations, and billing questions while maintaining confidentiality.
• Proficiency with Microsoft Office (Excel, Word), Google applications, and ability to learn electronic health record, billing, and practice management systems.

Preferred qualifications

• Experience in behavioral health, healthcare services, home and community‑based services, or another regulated service environment.
• Experience with Medicaid managed care, commercial insurance, Medicare, private pay, and secondary or tertiary billing workflows.
• Knowledge of denial trends, payor‑specific billing rules, timely filing requirements, and revenue cycle performance metrics.
• Certification in medical billing, coding, revenue cycle, or healthcare administration (optional).
• Experience working across multiple service lines and multiple locations.

Skills

• Strong attention to detail and accuracy in data entry, billing review, claim correction, and accounting documentation.
• Ability to manage multiple priorities, meet deadlines, and follow up consistently in a fast‑paced environment.
• Effective communication skills for interacting with payors, internal departments, clients, and leadership.
• Problem‑solving skills to research claim issues, identify root causes, and recommend process improvements.
• Ability to maintain confidentiality and handle sensitive financial and health information professionally.
• Dependable, organized, and able to work independently while contributing to team goals.

Reporting relationship

This position reports to the Director of Revenue Cycle or another designated revenue cycle leader and may receive daily workflow direction from revenue cycle management or WCG leadership depending on operational needs.

Work environment and physical requirements

• Maintains regular attendance and punctuality consistent with company expectations.
• Uses company‑approved systems and communication channels to complete billing responsibilities.
• Works collaboratively with cross‑functional teams to support accurate reimbursement and efficient revenue cycle operations.
• Maintains a professional, ethical, and client‑centered approach when handling billing matters.
• Ability to sit for extended periods while working at a computer, using billing systems, reviewing documentation, and completing data entry tasks.
• Ability to use a keyboard, mouse, telephone, copier, scanner, and other standard office equipment.
• Ability to read information on computer screens, claim forms, remittance documents, reports, and written correspondence.
• Ability to communicate clearly in person, by phone, and through electronic communication with payors, team members, leadership, and other stakeholders.
• Occasional ability to stand, walk, bend, reach, and lift or carry office files, records, supplies, or equipment weighing up to 15 pounds.
• Ability to perform repetitive hand and wrist movements related to typing, data entry, document review, and electronic billing activities.
• Reasonable accommodation may be made to enable qualified individuals with disabilities to perform essential functions.