Patient Account Representative

Position Summary:

The Patient Account Representative serves as a crucial link between patients and the complexities of medical billing for high-cost infusion therapies. This role focuses on providing clear, empathetic guidance to patients regarding their statements, financial obligations, and payment options. The position will be responsible for translating complex insurance and billing information into understandable terms, setting up payment plans, and connecting patients with financial assistance programs. Success in this position requires deep expertise in the entire revenue cycle, proficiency with billing platforms like AdvancedMD and Waystar, and a commitment to resolving patient accounts with compassion and accuracy.

Key Responsibilities

• Solve complex payment and coding issues, proactively troubleshooting accounts and working with patients and payers to resolve disputes.
• Conduct outbound patient calls to collect on outstanding balances, explain statements, and set up payment arrangements.
• Create and adjust payment plans based on realistic patient needs, verifying insurance, and connecting them with co-pay assistance or financial programs.
• Answer incoming calls about billing statements and balances for infusion treatments
• Translate complex financial info into plain language (deductibles, co-insurance, specialty drug costs, chair fees).
• Support patients with payments, payment plans, and connect them to co-pay/financial assistance resources.
• Educate patients on how insurance approvals and specialty pharmacy shipments impact their balances.
• Document every interaction in our billing system (AdvancedMD, Waystar, or similar).
• Collaborate with financial counselors, billing, and clinical teams to solve patient concerns.
• Lead by example in team environments, supporting colleagues, and identifying workflow improvements for the business office or clinic.

Required Knowledge and Skills

• Advanced problem-solving, communication, and organizational abilities.
• Understands the entire patient account lifecycle, including data entry, charge posting, insurance follow-up, coding review, and appeals for both government and commercial payers.
• Excellent written and verbal communication skills; translates clinical events (infusion scheduling, pharmacy shipment, prior authorization) into patient account impacts and communicates these clearly.
• Meets or exceeds productivity and quality benchmarks for account resolution, documentation accuracy, and patient satisfaction. Tracks time-to-resolution, A/R reduction, and dispute turnaround.
• Utilizes leading RCM platforms (Waystar, AdvancedMD) and payer portals with accuracy, using job aids and accessing payer websites efficiently for timely resolution.
• Maintains impeccable HIPAA and regulatory compliance and serves as a model of integrity in all patient and team communications.  
• Detail-oriented with demonstrated compliance and service excellence.

Education/Licensure/Technical Requirements.

• 2+ years’ specialization in infusion, specialty pharmacy, or RCM with measurable success.
• Certification or postsecondary coursework in Medical Office Administration accreditation.
• High School diploma or GED
• Ability to meet U.S. employment and eligibility requirements.

Qualifications