Patient Account Representative III - Professional Billing (Full Time, Day)

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.