Patient Account Representative

The Patient Accounts Representative II (PAR II) is responsible for accurate and timely healthcare billing, insurance claim submission, account follow-up, and collection activities. The position supports the organization’s revenue cycle by ensuring claims are submitted in accordance with payer requirements and applicable federal and state regulations, resolving billing and reimbursement issues, and maintaining accurate patient account information.

The PAR II monitors assigned accounts, identifies claim and payment issues, performs insurance follow-up, researches denials and pending claims, and takes appropriate corrective action to support timely reimbursement and maintain accounts receivable (A/R) within established organizational objectives.

In addition to the responsibilities of a PAR I, the PAR II demonstrates advanced knowledge of revenue-cycle operations and serves as a resource to the Patient Financial Services team. The PAR II is expected to independently resolve more complex billing, insurance, account, and reimbursement issues; communicate effectively with other departments and external stakeholders; and contribute to process improvement, staff development, and departmental initiatives.

The PAR II provides professional and courteous service to patients, insurance companies, medical staff, employees, and other internal and external contacts. The position requires sound judgment, attention to detail, effective communication, the ability to manage multiple priorities, and the ability to work independently with minimal supervision.

The PAR II is expected to demonstrate a higher level of technical proficiency, problem-solving ability, cross-functional knowledge, and accountability than the PAR I level.

Required Education

• High school diploma or equivalent.
• Completion of role-specific training and/or an approved revenue-cycle certification, as required by the organization’s career-path program.

Required Experience

• Minimum of one year of experience in the PAR I or equivalent role, with demonstrated proficiency in the required functions. Manager/Director Discretion may override.
• Employees with prior directly related healthcare billing or revenue-cycle experience may be eligible for advancement based on applicable organizational career-path guidelines.

Preferred Experience and Credentials

• Experience in healthcare billing, patient financial services, medical accounts receivable, insurance follow-up, or a healthcare business-office environment.
• Experience with healthcare revenue-cycle processes.
• Experience working with electronic patient accounting or billing systems.
• Working knowledge of HCPCS and revenue codes preferred.
• Completion of an applicable revenue-cycle or coding certification, such as CRCS, CPC, or CPB, preferred or required in accordance with the organization’s career-path guidelines.

PAR II Career-Path Requirements

To advance from PAR I to PAR II, the employee must meet the organization’s established career-path requirements, including:

• At least one year in the current position, unless otherwise permitted based on directly related prior experience. Manager/Director Discretion may override.
• Completion of the required continuing education units (CEUs) and/or approved certification requirements.
• Successful completion of required role-specific training and competency validation.
• Demonstrated proficiency in the PAR II competencies and cross-training requirements.
• Key Performance Indicators (KPIs) must be current and up to date. The employee must demonstrate sustained performance and may not have a negative trend in applicable KPIs for more than three consecutive months, unless otherwise approved by PFS management.
• Must remain current and compliant with all required HealthStream education, training, competencies, and hospital-mandated requirements.
• Must demonstrate the ability to train new team members and provide ongoing training, coaching, or competency support to individuals as needed.
• Must identify at least one denial trend, analyze the underlying issue, and present a recommended solution or corrective action to the Denials Coordinator and PFS management monthly.
• Must be cross-trained in at least one additional billing pod, as well as the Cashier/Poster or Financial Counselor position, in accordance with departmental cross-training requirements.
• Must demonstrate the ability to apply cross-training knowledge to assist with departmental coverage, workflow, problem resolution, and revenue-cycle operations.

PAR II employees are expected to maintain required continuing education, certification, HealthStream, hospital training, competency, cross-training, and performance requirements to remain in the PAR II classification.

Required Knowledge, Skills, and Abilities

• Strong attention to detail and accuracy.
• Strong analytical, organizational, and problem-solving skills.
• Ability to identify account discrepancies and determine appropriate follow-up actions.
• Ability to manage multiple priorities and meet established productivity and quality standards.
• Ability to work independently with minimal supervision.
• Strong interpersonal and customer-service skills.
• Professional verbal and written communication skills.
• Ability to interact effectively with patients, insurance representatives, medical staff, management, and other stakeholders.
• Ability to handle confidential information appropriately and maintain protected health information (PHI) in accordance with HIPAA and organizational requirements.
• Proficiency with computers and electronic information systems.
• Working knowledge of Microsoft Word and Excel preferred.
• Ability to adapt to changing payer requirements, regulations, systems, and departmental processes.
• Ability to work effectively in a fast-paced environment and manage stressful or challenging situations professionally.

Advanced PAR II competencies include:

• Ability to serve as a resource to PAR I staff and other Business Office personnel.
• Ability to independently research, analyze, and resolve complex billing, insurance, reimbursement, and patient-account issues.
• Ability to communicate complex revenue-cycle issues clearly to patients, payers, coworkers, management, and other departments.
• Ability to identify trends, recurring issues, and process gaps and recommend appropriate solutions.
• Ability to collaborate effectively with other departments or teams to resolve revenue-cycle issues and improve processes.
• Ability to assist with training, onboarding, and competency development of new and existing team members.
• Ability to perform advanced functions within applicable patient accounting, billing, payment, document management, and reporting systems.
• Ability to compile, organize, analyze, and present data using Microsoft Excel, Word, and applicable reporting tools.
• Ability to de-escalate difficult patient situations, establish appropriate payment arrangements within organizational guidelines, and perform account audits.

• Strong attention to detail and accuracy.
• Strong analytical, organizational, and problem-solving skills.
• Ability to identify account discrepancies and determine appropriate follow-up actions.
• Ability to manage multiple priorities and meet established productivity and quality standards.
• Ability to work independently with minimal supervision.
• Strong interpersonal and customer-service skills.
• Professional verbal and written communication skills.
• Ability to interact effectively with patients, insurance representatives, medical staff, management, and other stakeholders.
• Ability to handle confidential information appropriately and maintain protected health information (PHI) in accordance with HIPAA and organizational requirements.
• Proficiency with computers and electronic information systems.
• Working knowledge of Microsoft Word and Excel preferred.
• Ability to adapt to changing payer requirements, regulations, systems, and departmental processes.
• Ability to work effectively in a fast-paced environment and manage stressful or challenging situations professionally.

Position Summary:

The Patient Accounts Representative III (PAR III) is a senior-level revenue cycle professional responsible for advanced healthcare billing, insurance claim management, account resolution, reimbursement optimization, and collection activities. The position plays a key role in supporting the organization’s financial performance by ensuring complex claims and patient accounts are effectively managed in accordance with payer requirements, organizational policies, and applicable federal and state regulations.

The PAR III independently monitors assigned accounts, identifies trends and systemic issues affecting reimbursement and accounts receivable (A/R), and takes appropriate action to resolve barriers to payment. The position is responsible for applying advanced knowledge of revenue-cycle operations, payer requirements, billing practices, and organizational processes to resolve escalated issues and support timely and accurate reimbursement.

In addition to the responsibilities of a PAR II, the PAR III serves as a senior resource and subject-matter expert for the Patient Financial Services team. The position provides guidance and support to PAR I and PAR II staff, assists with complex or escalated account issues, shares knowledge of billing and reimbursement requirements, and helps promote consistency and accuracy across the department.

The PAR III may serve as a resource for training, onboarding, and development of staff and may assist leadership with identifying and addressing performance or workflow issues.

The PAR III is expected to take an active role in departmental and organizational initiatives that affect the revenue cycle. This includes identifying opportunities to improve processes, reduce denials and billing errors, strengthen collections, improve payer performance, and increase operational efficiency. The position may assist with developing and implementing process improvements, updating departmental procedures, researching payer or regulatory changes, and evaluating the impact of changes on billing and reimbursement operations.

The PAR III collaborates with Patient Financial Services leadership and other departments to investigate and resolve complex revenue-cycle issues and serves as a knowledgeable point of contact for internal and external stakeholders. The position may communicate with insurance representatives, patients, clinical and administrative departments, vendors, and other stakeholders regarding complex billing, reimbursement, and account matters.

The PAR III demonstrates a high degree of accountability, initiative, sound judgment, and independent decision-making. The position is expected to recognize issues before they become significant barriers to reimbursement, determine appropriate courses of action, escalate matters when necessary, and follow complex issues through resolution. The PAR III is accountable not only for the accuracy and timeliness of assigned work, but also for contributing to the overall effectiveness, financial performance, and continuous improvement of the Patient Financial Services department.

The PAR III is expected to demonstrate a higher level of technical expertise, critical thinking, problem-solving ability, leadership, cross-functional knowledge, communication, and accountability than the PAR II level.