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.