Patient Accounts Representative - Monday-Friday - Day Shift in Sikeston, Missouri at Missouri Delta Medical Center

Summary of Position:

The Patient Accounts Representative is responsible for the timely, accurate, and compliant processing of healthcare claims and the ongoing management of patient accounts receivable. This position performs insurance billing, claims submission, payment and denial follow-up, account reconciliation, and resolution of outstanding insurance balances for hospital and professional services.

The Patient Accounts Representative is responsible for maintaining assigned payer accounts, identifying and resolving billing discrepancies, researching claim rejections and denials, and ensuring claims are processed in accordance with federal and state regulations, payer-specific guidelines, contractual requirements, and Missouri Delta Medical Center policies and procedures.

This position requires working knowledge of healthcare revenue cycle processes, insurance reimbursement methodologies, UB-04 and CMS-1500 claim forms, and governmental and commercial payer requirements. The representative must demonstrate accountability for assigned work queues, maintain accurate and thorough account documentation, meet established productivity and quality expectations, and proactively identify opportunities to prevent recurring billing errors and reimbursement delays.

The Patient Accounts Representative reports directly to the Revenue Cycle Director or designated leadership and is expected to work independently while maintaining effective communication and collaboration with other departments, insurance carriers, patients, and external business partners.

Functions of Position:

1. Insurance Billing and Claims Submission

2. Insurance Follow-Up and Accounts Receivable Management

• Work assigned insurance accounts and electronic work queues according to established departmental priorities, aging requirements, and productivity expectations.
• Proactively follow up on unpaid, underpaid, and outstanding insurance claims to ensure timely reimbursement.
• Review accounts receivable aging reports, payer websites, clearinghouse reports, and other available resources to identify outstanding claims and determine appropriate follow-up actions.
• Contact insurance carriers to investigate claim status, payment delays, processing errors, and reimbursement discrepancies.
• Identify claims approaching timely filing limits and take appropriate action to prevent avoidable write-offs.
• Research and resolve insurance processing issues, including coordination of benefits, eligibility discrepancies, authorization requirements, medical necessity, and payer enrollment issues.
• Ensure all appropriate collection and follow-up efforts have been completed before transferring an account to patient responsibility or recommending an adjustment.
• Identify trends in unpaid claims, recurring payer issues, and reimbursement delays and communicate findings to management.
• Maintain ownership and accountability for assigned accounts until an appropriate resolution has been achieved.

3. Denial Management and Appeals

• Investigate, analyze, and resolve insurance claim denials, rejections, and payment discrepancies.
• Review explanation of benefits (EOBs), electronic remittance advice (ERA), and electronic payer correspondence to determine the reason for nonpayment or reduced reimbursement.
• Determine appropriate corrective action, including claim corrections, reconsiderations, appeals, additional documentation, or other payer-specific resolution processes.
• Prepare and submit appeals and supporting documentation within applicable payer deadlines.
• Identify recurring denial trends and communicate root causes to management for further investigation and corrective action.
• Distinguish between registration, authorization, coding, documentation, charge capture, medical necessity, and billing-related denials.
• Work collaboratively with Patient Access, HIM, Case Management, Clinical Departments, and other appropriate personnel to resolve issues affecting reimbursement.
• Ensure denied claims are appropriately documented and routed for additional review when resolution requires action outside the representative's authority.

4. Payment Review and Account Reconciliation

• Review insurance payments, contractual adjustments, and patient responsibility amounts to ensure accurate account balances.
• Assist with processing insurance remittance advice and payment posting activities as assigned.
• Identify underpayments, overpayments, incorrect contractual adjustments, and other reimbursement discrepancies.
• Research accounts with credit balances and identify the appropriate resolution or escalation process.
• Ensure contractual allowances and adjustments are applied in accordance with payer contracts and established departmental policies.
• Identify discrepancies between billed charges, payer reimbursement, and expected contractual reimbursement.
• Ensure patients are billed only for amounts determined to be their responsibility after applicable insurance processing and contractual adjustments.
• Report potential charge master issues, reimbursement discrepancies, and recurring payment variances to management.

5. Governmental and Commercial Payer Compliance

• Maintain working knowledge of Medicare, Missouri Medicaid, managed care, commercial insurance, and other applicable payer billing requirements.
• Interpret and apply payer-specific billing guidelines, reimbursement policies, and regulatory requirements.
• Utilize payer portals, clearinghouse applications, and other electronic resources to research claims, eligibility, denials, and reimbursement information.
• Maintain awareness of changes to payer billing requirements and communicate questions or concerns to management.
• Ensure all billing and collection activities are performed in compliance with applicable federal and state regulations, HIPAA requirements, payer contracts, and organizational policies.
• Maintain strict confidentiality of patient financial, medical, and demographic information.

6. Account Documentation and Communication

• Maintain accurate, complete, and timely documentation of all account activity in the hospital's patient accounting system.
• Document insurance telephone calls, payer correspondence, claim status inquiries, denial research, appeals, and follow-up actions.
• Scan, attach, and maintain supporting documentation within the appropriate patient account or electronic record.
• Communicate professionally and effectively with insurance representatives, patients, vendors, and internal departments.
• Respond to patient billing inquiries and direct questions requiring additional assistance to the appropriate personnel.
• Coordinate with external billing vendors and business office partners to obtain information necessary for account resolution.

7. Departmental Productivity, Quality, and Accountability

• Maintain assigned work queues and accounts according to established departmental procedures and priorities.
• Meet established productivity, quality assurance, accuracy, and turnaround time expectations.
• Demonstrate accountability for assigned responsibilities and complete work within established deadlines.
• Follow departmental standard operating procedures (SOPs), billing guidelines, and management directives.
• Maintain proficiency in the hospital's patient accounting system, electronic work queues, payer portals, and other assigned applications.
• Identify opportunities to improve workflow efficiency, reduce preventable denials, and improve reimbursement turnaround times.
• Participate in departmental meetings, training sessions, continuing education, and performance improvement initiatives.
• Complete required annual competency assessments and demonstrate continued proficiency in assigned job responsibilities.
• Assist with training new employees and cross-training within the department as assigned.

8. Professional Conduct and Organizational Responsibilities

• Understand and support Missouri Delta Medical Center's Mission, Vision, and Values, as well as organizational policies and Conduct Rules.
• Maintain a professional, respectful, and service-oriented approach when interacting with patients, visitors, coworkers, and external business partners.
• Demonstrate sound judgment, initiative, dependability, and the ability to work independently.
• Maintain regular and dependable attendance and adhere to established work schedules and departmental attendance policies.
• Accept responsibility for assigned duties, performance expectations, and work quality.
• Maintain a positive and cooperative working relationship with all departments and members of the healthcare team.
• Perform other duties as assigned by departmental leadership.

Qualifications:

Education:

• High school diploma or equivalent required.
• Additional education in medical billing, coding, healthcare administration, or business administration preferred.
• Medical billing and/or coding certification is preferred.

Experience:

• Minimum of six months to one year of experience in healthcare claims billing, medical accounts receivable, insurance follow-up, or a related revenue cycle position required.
• Experience with hospital or physician billing preferred.
• Experience working with Medicare, Medicaid, and commercial insurance payers preferred.
• Experience with electronic health records, patient accounting systems, clearinghouses, and payer portals preferred.

Knowledge and Skills:

• Working knowledge of healthcare revenue cycle processes and insurance claims management.
• Understanding of UB-04 and CMS-1500 billing requirements.
• Familiarity with CPT, HCPCS, ICD-10-CM, revenue codes, modifiers, and medical terminology.
• Knowledge of Medicare, Medicaid, and commercial insurance billing guidelines.
• Ability to interpret EOBs, ERAs, denial codes, and payer correspondence.
• Strong analytical, organizational, and problem-solving skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities and meet established deadlines.
• Ability to work independently with minimal direct supervision.
• Proficiency in Microsoft Office applications and general computer navigation.
• Ability to adapt to changing payer regulations, billing requirements, and departmental workflows.
• Demonstrates professionalism, initiative, accountability, and attention to detail.

Work Location: On-site in Sikeston, Missouri