Job Family :

PFS Billing

Travel Required :

None

Clearance Required :

None

What You Will Do :

The Patient Account Representative (PAR) serves as an extension of a client's business office staff and is responsible for managing specialized billing areas within Revenue Cycle Management, including transplants, workers' compensation, VA, specialty pharmacy, and miscellaneous agency work. This role involves both in-coming and out-going calls to insurance companies to resolve account balances and handle resubmission of claims. Work is performed in a supportive task management environment where the billing system assigns work based upon specific criteria. All client policies and standards operating procedures (SPO’s) are followed. Representatives will perform all job-related duties as assigned, which include but are not limited to:

Account Review:

• Review patient accounts for accuracy and completeness.

• Identify and correct billing errors or discrepancies.

Denials:

• Investigate and resolve denied claims.

• Prepare and submit appeal letters as necessary.

Medicare/Medicaid:

• Ensure compliance with Medicare and Medicaid billing regulations.

• Follow up on outstanding claims to secure payment.

Insurance Follow-up:

• Make out-going calls to insurance companies to check the status of claims.

• Take in-coming calls from insurance companies to address queries and issues.

Billing:

• Manage the resubmission of claims to ensure timely and accurate processing.

• Handle billing inquiries and discrepancies.

• Additional Responsibilities:

• Complete all business-related requests and correspondence from patients and insurance companies.

• Complete all assigned projects in a timely manner.

• Communicate to Guidehouse management areas of concern or areas of improvement.

• Strive to resolve account balances to zero prior to accounts being forwarded to an outside agency for collections.

What You Will Need :

• High School Diploma or GED

• Minimum of 1-year medical provider experience.

• Proficiency in computer skills in a Windows environment.

• Knowledge and utilization of desktop applications including Outlook, Word and Excel.

What Would Be Nice To Have :

• Healthcare billing experience.

• 1 year of customer service experience and/or analytical skills in a clinical or administrative environment.

• Experience with specialized healthcare billing

• Experience with healthcare information systems, particularly IDX and/or Epic.

• Certification in medical billing or coding (e.g., CPC, CPB) is a plus.

• Familiarity with electronic health records (EHR) and patient management systems.

• Self-driven and directed, with the ability to follow instructions when required.

Working Conditions:

• Primarily office-based with standard working hours.

• Occasional extended hours may be required to meet deadlines or resolve urgent issues.

What We Offer :

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.