Patient account representatives hold administrative roles at hospitals, medical facilities, and private businesses that specialize in patient financial responsibilities. They maintain general patient information and financial data associated with diagnoses, treatments, payments and health insurance coverage, as it relates to medical services. Account representatives process claims, address overdue accounts, and initiate collections when necessary, but they do not treat patients, prescribe medications or make patient-related decisions about care.
Patient Financial Files
Patient account representatives maintain patient financial files to ensure all medical bills are paid. Account representatives must be familiar with Medicaid and Medicare billing practices and electronic clearinghouse methods, so they can accurately report unpaid claims and determine the financial responsibility of patients, according to the Erie Family Health Center in Chicago, Illinois. Account representatives must possess strong administrative and mathematical skills, so they can accurately calculate patient invoices and effectively submit, send and record claims, payments and overdue notices.
Account representatives must possess detail-oriented strengths to recognize mathematical errors, underpayments, overpayments and past-due accounts. Overdue accounts might be the result of patient address changes, typing errors, medical coding mistakes or insurance company shortcomings. Or, they could be the result of patients' inability or unwillingness to pay for medical treatment. Account representatives often have to chase down discrepancies and follow up on past-due accounts by contacting patients, medical facilities, doctors, lawyers and insurance agents. Familiarity with accounting software and medical codes is advantageous.
When patients are unable to pay for their medical expenses, account representatives work as mediators to create payment plans that are acceptable to providers and affordable for patients. They often consider a patient's income, other financial obligations and debt load to determine fair payment options. Once payment plans are established, account representatives oversee the payments to ensure patients pay on time and follow through with their new, often reduced, financial commitments. When patients refuse to meet contractual payment plan guidelines, account representatives submit the delinquencies to collection agencies.
Because patient account representatives interact with patients, medical professionals and insurance agents on a regular basis, effective interpersonal skills are a plus. Account representatives need strong communication skills, so they can negotiate fair payment options and explain the requirements in verbal and written form. They must maintain a friendly tone when talking with patients, so they don't appear frustrated, disappointed or impatient. Due to the private nature of medical diagnoses and treatments, account representatives must carefully respect patient confidentiality.
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