Under the direction of the Patient Financial Services Manager, the Patient Account Representative III (PAR-III) is responsible for the accurate and timely billing, follow-up, and collection of ambulatory patient accounts. This role ensures accounts are processed in accordance with standard and NorthBay-specific billing practices, as well as all applicable regulatory requirements.
The PAR-III manages patient accounts across multiple services and specialties within NorthBay Ambulatory practices and plays a key role in achieving optimal reimbursement outcomes and maintaining compliance with healthcare billing standards.
Primary Responsibilities
- Perform timely follow-up on accounts with practices, payers, and/or patients until a zero balance is achieved per contract and payment expectations.
- Monitor and manage assigned accounts receivable to meet or exceed AR aging goals.
- Process all initial billing claims promptly, including resolution of edits.
- Address and resolve payer denials efficiently to maximize reimbursement.
- Assist with backlogs and other duties as assigned to support departmental needs.
- Participate in workload reassignment to address priority areas.
- Deliver excellent customer service by maintaining a pleasant, professional demeanor and managing conflict resolution promptly.
- Respond to verbal and written inquiries accurately and in a timely manner.
Education Requirements
- High School Diploma or equivalent.
Experience Requirements
- Minimum 5 years of experience in professional billing, with in-depth knowledge of CPT, ICD, and HCPCS coding.
- Understanding of payer contracts, payment structures, and federal/state regulations.
- Proficiency with compliance and collection laws.
Skills & Competencies
- Excellent oral and written communication skills.
- Proficiency in PC applications, EMR/EHR, and billing systems.
- Strong analytical skills with attention to detail.
- Effective time management and ability to prioritize multiple tasks.
- Strong customer service skills, with the ability to resolve concerns diplomatically.
- Commitment to NorthBay's True North values.
- Team-oriented mindset with a collaborative approach to problem-solving.
- Ability to maintain professionalism and tact in all interactions.
Performance Standards
- Ensure timely and accurate billing, claim edits, and follow-up.
- Apply sound analytical skills in researching and resolving claim issues.
- Utilize all available resources, tools, and systems consistently.
- Actively participate in team collaboration to overcome claim barriers.
- Support special projects, attend meetings, and participate in training opportunities.
- Meet assigned quality and productivity standards consistently.
- Manage time effectively to achieve productivity requirements.
- Adhere to departmental expectations regarding breaks, time-off requests, shift assignments, and attendance.
- Maintain confidentiality and professional communication at all times.
- Comply with facility-wide policies, safety guidelines, emergency protocols, applicable laws, and payer contracts.
- Uphold professional standards in conduct and performance.
- Demonstrate adaptability and willingness to assist in cross-functional initiatives as needed.
Certification Requirement
- All new hires will be required to complete the HFMA Certified Revenue Cycle Representative (CRCR) training course within the first nine (9) months of employment.
- Membership, training, and certification costs will be sponsored by the employer.