Patient Account Representative – Medicare, Medicaid, Commercial Claims

Guidehouse

Insurance Patient Account Representative handling Medicare, Medicaid, and Commercial Claims for clients. Involved in billing, collections, and patient interactions to ensure account resolutions.

Posted 5/10/2026full-timeRemote • 🇺🇸 United StatesJunior💰 $34,000 - $56,000 per yearWebsite

About the role

Key responsibilities & impact

The Insurance Patient Account Representative is an extension of a client’s business office staff
Representatives are responsible for taking in-coming and making out-going calls to patients and insurance companies to resolve account balances
Facilitates the billing and collection processes of outstanding accounts receivable
Communicates with internal and external contacts to explain primary, secondary and tertiary billing, collection and resolution of claims including Medicare and other government and nongovernment accounts
Monitors daily queues for customer services/quality and productivity to maintain acceptable level as established by the departments; alerts management of high call volume patterns
Handles incoming and outgoing billing correspondence and phone inquiries relating to patient, third party administrators, attorneys, vendors and other insurance payers
Documents conversations and/or actions taken to support all claims inquiries, review and/or reconsiderations; streamlines the follow-up process of team members assisting on the file
Analyzes claims to determine compliant and accurate coding, charging; reviews file to confirm demographic and billing information is updated
Works to resolve any claim or billing concerns and takes appropriate action to escalate issues to management when appropriate
Performs follow-up processes on accounts to work towards a zero balance
Files a timely reconsideration or review of claim with supporting documentation such as a corrected claim, medical records and letter of explanation as necessary; communicates with departments to gather information needed to resolve the claim
Performs balance transfers UB-04 & CMS 1500
Complete all business-related requests and correspondence from patients and insurance companies
Responsible for working on average 35 Accounts Per Day
Complete all assigned projects in a timely manner
Assist client and patients in all requested tasks
Communicate to Guidehouse management areas of concern or areas of improvement
Research and respond to all patient inquiries received by telephone and mail
Update patient demographic information and initiate account adjustments
Try to resolve account balances to zero prior to accounts being forwarded to an outside agency for collections

Requirements

What you’ll need

High School Diploma / GED or 3 years of Relevant Equivalent Experience in Lieu of Diploma / GED
6 months - 2+ year's experience in office, business, operations, customer service or healthcare field
Previous experience working in insurance portals
PC skills in a Windows environment
Knowledge and utilization of desktop applications to include Word and Excel is essential
Ability to initiate and follow through on projects and work independently with minimal supervision

Benefits

Comp & perks

Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

billingcollectionsclaims analysiscodingaccount adjustmentsbalance transfersUB-04CMS 1500customer servicedata entry

Soft Skills

communicationproblem-solvingindependenceattention to detailtime managementorganizational skillsteam collaborationadaptabilityinitiativecustomer focus

Certifications

High School DiplomaGED