Clerical 85303 - Capitation Full-Time Days 8 Hour 8:00am


Under general supervision, Patient Account Rep follows procedures for verification of insurance eligibility and benefits, obtaining authorizations for care, where necessary, billing and collection of patient revenues, maximizing reimbursements, cash flow and maintaining low receivables, while also maintaining compliance with established state and federal regulations and Joint commission Standards and excellent customer relations.

Core Competencies

Reviews status of work queues and prioritizes job functions to ensure timely follow-up on patient accounts.
Assists in gathering documentation necessary to respond to the initial data requests and any subsequent appeals.
Receives and answers inquiries from patients and insurance companies regarding charges and/or billing discrepancies.
Promotes positive customer relations.
Reviews Explanation of Benefits (EOB’s) and Remittance Advices (RA’s) and completes appropriate follow up which may include appealing full or partial denials, billing any unpaid balance to a secondary insurer, if one exists, or submitting the claim for the unpaid balance to the patient.
Complies and submits for approval the supporting documentation for accounts to be granted a charity allowance or referred to an outside collection agency for further collection action.
Identifies and resolves problem or issues.
Elevates issues as appropriate to Supervisor.

Department Specific Competencies


High School Diploma/GED or Higher EducationN/A
Additional Information


Number of Years ExperienceType of Experience
1Billing/Collection experience in a Medical office or hospital
Additional Information

License / Certification Requirements