Account Representative

Position Summary:

The Account Representative supports the revenue cycle by preparing, reviewing, and submitting accurate medical claims to third-party payers in accordance with regulatory standards and payer-specific guidelines. This role ensures complete and accurate account documentation while working collaboratively with clinical teams, patient access staff, coders, and other billing personnel to gather required information and resolve discrepancies efficiently. As part of a coordinated revenue cycle team, the Account Representative contributes to timely reimbursement, reduced accounts receivable delays, and the overall financial health of the organization through consistent communication and shared accountability. This position plays an important role within a structured, supportive work environment that values teamwork, accuracy, and strong cross-departmental collaboration.

Key Responsibilities:

• Prepare, review, and submit compliant medical claims through approved billing and electronic data interchange systems.
• Verify accuracy of patient demographics, insurance information, coding, and supporting documentation prior to claim submission.
• Collaborate with internal departments to obtain missing or corrected information required for claim completion.
• Monitor the status of submitted claims, identify delays, and resolve issues that impact timely reimbursement.
• Review and correct denied or rejected claims, ensuring resubmission within payer timelines and regulatory requirements.
• Maintain comprehensive documentation of billing activities, communications, and follow up actions within the billing system.
• Recognize patterns in payer denials, documentation deficiencies, or workflow issues and notify appropriate leadership.
• Assist with internal audits and quality improvement initiatives related to billing accuracy and compliance.
• Maintain current knowledge of billing regulations, payer requirements, and updates to coding and documentation standards.

Licenses and Certifications Required:

• None

Educational Requirements:

• High School Diploma or equivalent is preferred.

Experience Requirements:

• One (1) year experience in accounting or clerical environment preferred.
• Six (6) months experience in processing insurance claims preferred.
• One (1) year experience in customer service preferred.
• Previous computer, word processing, and Excel experience preferred.
• Six months previous billing or cash posting to accounts receivable preferred.

Special Skills or Training Requirements:

• Good communication skills required.
• Good accounting aptitude required.
• Ability to key quickly and accurately required.
• Medical terminology and coding knowledge helpful but not required.

Physical Requirements:

The position requires the ability to work for extended periods at a computer based workstation with sustained focus and accuracy. Frequent hand and finger use is required for typing, data entry, navigating billing platforms, and handling documents. Visual clarity is necessary for reviewing detailed claim information, numerical data, and digital records. The job may involve occasional standing, walking, or retrieving documents, but is primarily sedentary. The role requires the ability to maintain concentration during repetitive tasks and perform work with consistent precision.

Environmental Requirements: Work is conducted in a standard office or hybrid business services environment with minimal exposure to physical hazards. The role involves constant interaction with computers, digital billing tools, payer portals, and communication devices. The environment is fast paced and deadline driven, requiring adaptability to changes in billing requirements, payer policies, and workflow priorities. The Account Representative works closely with a multidisciplinary team and must be comfortable managing frequent communication and administrative demands in a structured, compliance focused setting.