Revenue Cycle Patient Account Representative I

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Monday-Friday

Dayshift

Job Summary: The Revenue Cycle Patient Account Representative I supports Saint Francis Health System (SFHS) by ensuring patients experience clear, accurate, and timely resolution of their accounts. This role plays a key role in reducing financial stress for patients by helping ensure their insurance claims are processed correctly, questions are answered promptly, and issues are resolved efficiently. Working both independently and collaboratively, the representative helps patients navigate the billing process with transparency and compassion, contributing to a positive overall care experience. Communication occurs through Epic with physician offices and clinical areas, as well as through payer portals or telephone calls with third-party carriers to prevent delays and ensure patients receive accurate and fair account outcomes.

Minimum Education: High School diploma, or GED.

Licensure, Registration and/or Certification: None.

Work Experience: None. 1 year of experience in a health insurance field, preferred.

Knowledge, Skills, and Abilities: Knowledge of Microsoft 365 and other applicable software. Knowledge of all general office equipment. Basic knowledge of healthcare and insurance terminology. Working knowledge of medical billing and insurance follow-up processes. Excellent communication skills, both written and verbal, that present clear and concise information. Effective interpersonal, problem solving, and customer service skills. Strong financial, analytical, and decision-making skills. Excellent organizational skills. Strong ability to work in a team and professional environment. Sound ability to organize and prioritize work and be detail oriented. Ability to work independently and collaboratively in a fast-paced environment, managing multiple priorities with competing deadlines. Ability to navigate insurance websites to access patients' eligibility and payment information.

Essential Functions and Responsibilities: Responsibilities may include a variety of patient account management activities, with specific areas of focus assigned based on departmental needs. Verifies insurance coverage and ensures accurate representation of information on patient accounts. Manages and works through assigned work queues. Processes tasks such as reviewing, handling follow-up actions, and ensuring timely resolution of work queue items. Maintains positive work relationships, contributes to a team environment, and supports department goals through Quality Assurance and educational activities. Participates in Epic upgrades and transitions. Adheres to Health Insurance Portability and Accountability Act (HIPAA) compliance and standards, ensuring all patient information is handled with the utmost confidentiality and in compliance with privacy regulations. Ensures compliance with No Surprise Act (NSA) requirements for proper financial handling and patient notifications. Reviews claims for accuracy, monitors electronic transmissions, researches rejections, and ensures proper posting of payments and adjustments in compliance with contracts and regulations. Conducts follow-up on outstanding balances by contacting insurance carriers, patients, and other stakeholders, documenting account activity clearly and accurately. Resolves denials and underpayments through appeals, rebills, and corrected claims using payer websites, Epic functionality, and other tools. Identifies and addresses billing, coding, or demographic issues; updates account information; and requests additional documentation as needed. Provides support to teammates, assists with training, and helps maintain productivity and quality standards. Maintains compliance with state, federal, and payer requirements, applying knowledge of Medicare, Medicaid, commercial, and managed care payers. Communicates professionally with patients, payers, and internal departments, escalating issues when appropriate. Monitors trends, system issues, and payer behaviors to prevent delays, reduce aging, and support efficient revenue cycle operations.

Decision Making: Independent judgment in making minor decisions where alternatives are limited and standard policies/protocols have been established.

Working Relationships: Works directly with patients and/or customers. Works with internal and/or external customers via telephone or face to face interaction. Works with other healthcare professionals and staff.

Special Job Dimensions: None.

Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

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