Patient Account Representative - Medicare, Medicaid, Commercial Claims

Description

The Insurance Patient Account Representative works as an extension of a client’s business office, handling inbound and outbound calls to patients and insurance companies to resolve account balances, following client policies and procedures, and performing any assigned duties.

They facilitate billing and collection of outstanding receivables, communicate primary, secondary and tertiary billing issues with internal and external contacts, monitor daily queues for quality and productivity, and handle billing correspondence and phone inquiries from patients, third‑party administrators, attorneys, vendors and insurers. They document conversations, analyze claims for proper coding and demographics, resolve billing concerns, escalate issues when needed, and perform follow‑up processes to achieve zero balances, including filing reconsiderations with supporting documentation.

The role requires processing an average of 35 accounts per day, completing business‑related requests, assisting clients and patients, communicating concerns to Guidehouse management, researching and responding to patient inquiries via phone and mail, updating demographic information, and initiating account adjustments to prevent referral to external collection agencies.

• Facilitate billing and collection of outstanding receivables.
• Communicate billing issues with patients, insurers, and internal teams.
• Monitor daily queues for quality, productivity, and call volume trends.
• Handle inbound/outbound billing correspondence and phone inquiries.
• Document conversations and actions to support claim inquiries.
• Analyze claims for accurate coding, charges, and demographics.
• Resolve billing concerns and escalate issues when necessary.
• Perform follow‑up to drive accounts toward zero balance.
• File claim reconsiderations with supporting documentation.
• Execute balance transfers using UB‑04 and CMS 1500 forms.
• Process ~35 accounts daily and complete assigned projects timely.
• Research and respond to patient inquiries via phone and mail.
• Update patient demographics and initiate account adjustments.
• Prevent accounts from being sent to external collection agencies.

Requirements

Candidates need a High School Diploma/GED or three years of equivalent experience, and six months to two+ years of experience in an office, business, operations, customer service, or healthcare setting. Preferred qualifications include experience with insurance portals, proficiency in a Windows environment, solid Word and Excel skills, and the ability to work independently with minimal supervision.

• Meet required qualifications: High School Diploma/GED or 3 years equivalent experience; 6 months‑2+ years relevant experience.
• Preferred skills: insurance portal experience, Windows PC proficiency, Word and Excel.
• Work independently with minimal supervision.

Benefits

The annual salary ranges from $34,000 to $56,000, based on factors such as skills, experience, and certifications. Guidehouse offers a comprehensive total rewards package including medical, dental, vision, prescription coverage, paid sick time and holidays, discretionary bonus potential, parental leave, 401(k), life insurance, HSA, flexible spending accounts, disability coverage, tuition reimbursement, professional development, employee referral program, corporate events, and emergency backup childcare.

Training + Development

Interview process

Visa Sponsorship

Security clearance