Patient Account Representative

Position Summary

The Patient Account Representative supports the revenue cycle operations of Winners Circle Group by preparing, reviewing, submitting, and tracking claims across a multi-payor billing environment. This role helps ensure accurate and timely billing to commercial insurance plans, Medicare, Medicaid, managed care organizations, self-pay accounts, and other payor sources, while supporting compliance with applicable billing guidelines and internal revenue cycle procedures.

The Patient Account Representative reports to the Director of Revenue Cycle Management (RCM), or an assigned revenue cycle leader, and works closely with intake, authorization, clinical, finance, and administrative teams to support accurate payment posting, claim resolution, account follow-up, and clean claims submission.

Essential Duties and Responsibilities

• Prepare, review, and submit accurate claims through electronic billing systems, clearinghouses, payor portals, and paper claim processes as needed.
• Support billing across multiple payor types, including commercial insurance, Medicare, Medicaid, and other contracted payor arrangements.
• Verify billing information for completeness, including demographic data, coverage details, authorizations, service documentation, diagnosis information, service dates, rates, and required supporting records.
• Monitor claim status, rejection reports, clearinghouse edits, and payor portal updates to identify and correct billing issues promptly.
• Follow up on unpaid, denied, rejected, or underpaid claims and escalate recurring issues to the Director of Revenue Cycle or designated leader.
• Assist with denial research, correction, rebilling, reconsideration requests, and appeals by gathering needed documentation and payor-specific information.
• Post payments, adjustments, recoupments, denials, and contractual allowances accurately based on explanation of benefits, electronic remittance advice, payor correspondence, and internal procedures.
• Maintain organized billing records, account notes, correspondence, and supporting documentation in accordance with company standards and retention requirements.
• Coordinate with intake, authorization, clinical, and administrative staff to resolve missing information, service discrepancies, documentation gaps, and authorization-related billing barriers.
• Review accounts receivable aging and assist with timely follow-up to reduce outstanding balances and support cash flow objectives.
• Support patient accounting activities, including collecting patient co-pays, discussing account balances with patients in a clear and professional manner, and documenting payment arrangements or follow-up needs in accordance with company procedures.
• Assist with account reconciliation by reviewing patient account balances, payments, adjustments, unapplied funds, and outstanding balances to help ensure billing records are accurate and current.
• Respond professionally to payor, client, and internal billing inquiries while maintaining confidentiality and a service-focused approach.
• Support month-end close activities, billing audits, reporting requests, reconciliation projects, and other revenue cycle initiatives as assigned.
• Maintain knowledge of payor rules, billing requirements, timely filing limits, documentation standards, and company procedures related to revenue cycle operations.
• Perform all duties in accordance with HIPAA, payer requirements, organizational policies, and applicable federal, state, and local regulations.

Required Qualifications

• High school diploma or equivalent required; associate or bachelor’s degree in business, healthcare administration, accounting, or a related field preferred.
• Minimum of 3 to 5 years of experience in medical billing, healthcare revenue cycle, accounts receivable, payment posting, claims follow-up, or related administrative billing work preferred.
• Experience working with multiple payors, payor portals, clearinghouses, electronic remittance advice, explanation of benefits, and billing software preferred.
• Working knowledge of healthcare billing processes, insurance verification, claim submission, denial follow-up, payment posting, and accounts receivable practices.
• Basic understanding of CPT, HCPCS, ICD-10, modifiers, authorization requirements, and medical or behavioral health terminology preferred.
• Experience handling patient payment transactions, including collecting co-pays, documenting payments, and following established cash-handling or payment processing procedures.
• Ability to communicate professionally and sensitively with patients regarding account balances, payment expectations, billing questions, and follow-up needs while maintaining confidentiality.
• Working knowledge of patient account reconciliation, including reviewing balances, payments, adjustments, unapplied funds, and outstanding account activity for accuracy.
• Proficiency with Microsoft Office applications, particularly Excel, and Word, Google applications, and ability to learn electronic health record, billing, and practice management systems.

Knowledge, Skills, and Abilities

• Strong attention to detail and accuracy in data entry, billing review, claim correction, and accounting documentation.
• Ability to manage multiple priorities, meet deadlines, and follow up consistently in a fast-paced revenue cycle environment.
• Effective communication skills for interacting with payors, internal departments, clients, and leadership.
• Problem-solving skills with the ability to research claim issues, identify root causes, and recommend process improvements.
• Ability to maintain confidentiality and handle sensitive financial and health information with professionalism.
• Dependable, organized, and able to work independently while contributing to team goals.

Preferred Qualifications

• Experience in behavioral health, healthcare services, home and community-based services, or another regulated service environment.
• Experience with Medicaid managed care, commercial insurance, Medicare, private pay, and secondary or tertiary billing workflows.
• Knowledge of denial trends, payor-specific billing rules, timely filing requirements, and revenue cycle performance metrics.
• Certification in medical billing, coding, revenue cycle, or healthcare administration is a plus but is not required.
• Experience working across multiple service lines and multiple locations a plus

Reporting Relationship

This position reports to the Director of Revenue Cycle or another designated revenue cycle leader. The role may receive daily workflow direction from revenue cycle management, or WCG leadership depending on operational needs.

Work Environment, Expectations, and Physical Requirements

• Maintains regular attendance and punctuality consistent with company expectations.
• Use company-approved systems and communication channels to complete billing responsibilities.
• Works collaboratively with cross-functional teams to support accurate reimbursement and efficient revenue cycle operations.
• Maintains a professional, ethical, and client-centered approach when handling billing matters.
• Performs other duties as assigned to support the goals of Winners Circle Group and the revenue cycle department.
• Ability to sit for extended periods while working at a computer, using billing systems, reviewing documentation, and completing data entry tasks.
• Ability to use a keyboard, mouse, telephone, copier, scanner, and other standard office equipment for routine work activities.
• Ability to read information on computer screens, claim forms, remittance documents, reports, and written correspondence with or without reasonable accommodation.
• Ability to communicate clearly in person, by phone, and through electronic communication with payors, team members, leadership, and other stakeholders.
• Ability to occasionally stand, walk, bend, reach, and lift or carry office files, records, supplies, or equipment weighing up to 15 pounds.
• Ability to perform repetitive hand and wrist movements related to typing, data entry, document review, and electronic billing activities.
• Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the essential functions of the role.

 

This job description is not intended to create an employment contract, express or implied, and employment with Winners Circle Group of Texas remains at-will, meaning either the employee or the company may end the employment relationship at any time, with or without cause or notice, in accordance with applicable law.  Winners Circle Group of Texas is an equal opportunity employer.