Senior Patient Accounting Representative

Position Summary

The Senior Patient Accounting Representative is a senior-level revenue cycle professional responsible for supporting the timely, accurate, and complete conversion of patient services into cash. This position performs complex billing, insurance follow-up, account resolution, denial management, and collection activities while serving as a subject-matter resource for Patient Accounting staff.

The Senior Patient Accounting Representative is expected to demonstrate ownership of revenue cycle outcomes, with particular emphasis on clean claims, unbilled days, days in accounts receivable, accounts receivable aging, and cash collections. The position proactively identifies barriers to reimbursement, determines root causes, recommends corrective action, and works collaboratively with internal departments and external payers to improve revenue cycle performance.

The position also supports departmental leadership through staff education, mentoring, workflow improvement, performance monitoring, and implementation of organizational revenue cycle initiatives.

Essential Duties and Responsibilities

Claims Management and Clean Claim Performance

• Prepare, review, correct, and submit medical claims to insurance companies accurately and within established billing and timely-filing requirements.
• Review coded procedures, diagnoses, treatments, charges, demographic information, insurance information, and other claim components for billing accuracy and completeness.
• Maintain responsibility for achieving established organizational clean claim and first-pass acceptance targets.
• Identify and resolve claim edits, rejections, missing information, coding discrepancies, payer-specific requirements, and other issues preventing successful claim submission.
• Monitor rejected and returned claims and ensure corrections and resubmissions occur promptly.
• Analyze recurring claim errors and rejections by payer, provider, department, error type, and root cause.
• Communicate recurring issues to appropriate departments and management and recommend corrective actions designed to prevent future claim defects.
• Monitor billing data feeds and system interfaces for abnormal trends or conditions that may indicate potential billing errors or interruptions.

Unbilled Accounts and Billing Readiness

• Monitor assigned unbilled account inventory and take appropriate action to ensure accounts are billed as quickly and accurately as possible.
• Maintain assigned unbilled inventory within established organizational unbilled-days and/or DNFB targets.
• Identify coding, documentation, charge capture, registration, authorization, insurance, interface, system, or other barriers preventing accounts from progressing to final bill.
• Prioritize high-dollar and aging unbilled accounts for resolution.
• Coordinate with Patient Access, Coding, Health Information Management, clinical departments, providers, Information Technology, and other departments to resolve billing barriers.
• Escalate accounts and systemic issues that exceed established unbilled thresholds or cannot be resolved through normal processes.
• Quantify and trend recurring causes of unbilled accounts and recommend process improvements designed to reduce unbilled days.

Accounts Receivable Management

• Actively manage assigned accounts receivable inventory to support achievement of the organization's established net days in accounts receivable target.
• Perform timely and effective insurance follow-up on unpaid, underpaid, denied, rejected, or otherwise unresolved accounts.
• Prioritize account activity based on age, dollar value, payer requirements, timely-filing limitations, denial risk, collection probability, and other established criteria.
• Maintain assigned accounts within organizational A/R aging targets, with particular emphasis on preventing and reducing receivables greater than 90 days.
• Research complex account balances and determine the appropriate action necessary to achieve payment or final account resolution.
• Contact payers as necessary to determine claim status, payment requirements, denial reasons, or additional information needed for adjudication.
• Document account activity completely and accurately in accordance with organizational standards.
• Escalate payer delays, systemic processing issues, and high-risk accounts when appropriate.
• Prevent avoidable timely-filing losses and unnecessary write-offs through effective account prioritization and follow-up.

Cash Collections

• Maintain direct accountability for supporting achievement of established monthly cash collection targets.
• Manage assigned payer, account, or business-unit inventories to maximize reimbursement and accelerate cash collections.
• Monitor actual collections and account resolutions against established goals.
• Identify significant collection variances, determine contributing factors, and communicate findings to management.
• Identify opportunities to accelerate cash through focused payer follow-up, claim correction, denial resolution, appeals, rebilling, and escalation.
• Work collaboratively with management and other revenue cycle functions to address operational or payer issues negatively affecting cash collections.
• Support departmental and organizational initiatives designed to achieve or exceed established cash goals.

Denial and Underpayment Management

• Research and resolve claim denials, payment variances, underpayments, and other reimbursement discrepancies.
• Determine root causes of preventable denials and recommend corrective action.
• Prepare and submit appeals, corrected claims, reconsiderations, and supporting documentation when appropriate.
• Monitor recurring denial patterns and communicate findings to management.
• Quantify the operational and financial impact of significant recurring denial issues when appropriate.
• Collaborate with upstream departments to prevent recurrence of registration, authorization, coding, documentation, charge capture, and other avoidable revenue cycle defects.

Process Improvement and Problem Resolution

• Proactively identify, communicate, quantify, and monitor account-level and workflow barriers affecting revenue cycle performance.
• Analyze recurring problems and recommend process improvements or corrective actions to management.
• Trend recurring issues so that problems can be corrected at their point of origin whenever possible.
• Participate in implementation and monitoring of approved process improvements.
• Use available data and reporting tools to identify performance outside established standards or expected operating ranges.
• Complete special projects accurately and within established deadlines.
• Maintain proficiency in all assigned daily transactions, functions, systems, and workflows.

Leadership, Training, and Staff Support

• Serve as a senior departmental resource for complex billing, collection, payer, denial, and account-resolution issues.
• Share subject-matter expertise with Patient Accounting staff.
• Assist with onboarding, education, training, and development of new and existing staff.
• Provide guidance and mentoring to less-experienced team members.
• Promote adherence to established billing, follow-up, collection, documentation, and account-resolution policies and procedures.
• Assist in ensuring departmental policies, procedures, and guidelines are accurate, accessible, understood, and consistently applied.
• Support management and organizational initiatives and demonstrate leadership consistent with departmental objectives.
• Promote accountability, teamwork, professionalism, and continuous improvement throughout the department.

Key Performance Indicators and Accountability

The Senior Patient Accounting Representative is accountable for contributing to achievement of organizational revenue cycle objectives. Individual and departmental performance may be measured against established targets including:

• Clean Claim / First-Pass Acceptance Rate — Meet or exceed established organizational target.
• Unbilled Days / DNFB — Maintain assigned inventory at or below established target.
• Net Days in Accounts Receivable — Support achievement of the organizational A/R-days target through effective management of assigned inventory.
• Cash Collections — Meet or exceed established monthly collection expectations for assigned responsibilities.
• A/R Aging — Maintain assigned inventory within established aging targets and minimize balances greater than 90 days.
• Denials and Claim Rejections — Maintain performance within established targets and demonstrate reduction of preventable denials and rejections.
• Timely Filing — Minimize or eliminate avoidable timely-filing write-offs.
• Productivity — Meet established account follow-up, billing, collection, and resolution productivity standards.
• Quality and Accuracy — Meet established quality standards for account documentation, claim processing, financial transactions, and account resolution.

Performance targets may be established and periodically revised by Revenue Cycle leadership based on organizational objectives, payer mix, business requirements, and industry performance standards.

Senior-Level Accountability

The Senior Patient Accounting Representative is expected to demonstrate ownership of revenue cycle outcomes rather than solely completing assigned transactions.

This includes the ability to:

• Recognize performance variances and emerging revenue cycle problems.
• Investigate and determine root causes.
• Quantify the operational or financial impact when appropriate.
• Take corrective action within the scope of the position.
• Escalate unresolved barriers in a timely manner.
• Recommend practical solutions to management.
• Assist with implementation of corrective actions.
• Monitor results to determine whether corrective actions are effective.