Patient Financial Service Representative

Position Summary

The Patient Financial Services Representative is responsible for reviewing patient accounts to ensure accurate patient balances, resolving patient billing inquiries and escalations, and working directly with patients and insurance carriers to address account discrepancies. This role serves as a key liaison between patients, clinics, and the Revenue Cycle Management team to ensure patients receive clear, accurate billing information and that all balances are appropriately adjudicated before patient responsibility is assigned.

The ideal candidate has strong healthcare billing knowledge, excellent customer service skills, and the ability to independently investigate account issues, verify insurance coverage, refile claims when appropriate, and resolve complex patient billing concerns with professionalism and empathy.

Essential Duties and ResponsibilitiesPatient Billing Escalations

• Manage escalated patient billing inquiries received through phone, email, tickets, and clinic referrals.

• Research patient accounts to identify the root cause of billing concerns and provide clear explanations to patients.

• Resolve disputes related to patient balances, insurance processing, payments, adjustments, refunds, and billing questions.

• Maintain professional and empathetic communication with patients while adhering to company policies.

• Escalate unusual, high-risk, or compliance-related issues to leadership when appropriate.

Account Review and Balance Validation

• Review self-pay and patient responsibility accounts to ensure balances are accurate and supported by claims adjudication.

• Analyze EOBs, ERAs, payment postings, adjustments, and account activity to validate patient balances.

• Identify potential billing errors, missing insurance payments, duplicate charges, incorrect adjustments, or misapplied payments.

• Recommend and process account corrections according to established policies and procedures.

• Document findings and resolutions thoroughly within the practice management system.

Insurance Follow-Up and Claim Resolution

• Identify accounts that should be billed or rebilled to insurance rather than assigned to patient responsibility.

• Verify payer eligibility, coverage, and coordination of benefits when applicable.

• Refile corrected claims and submit claim reconsiderations as needed.

• Research claim denials and rejections impacting patient balances.

• Collaborate with AR, billing, payment posting, credentialing, and clinic teams to ensure accurate claim outcomes.

Verification of Benefits

• Perform insurance verification for patients when coverage questions arise.

• Confirm eligibility, benefits, coverage limitations, copays, deductibles, coinsurance, and authorization requirements.

• Update patient accounts with accurate insurance information.

• Communicate insurance findings to patients and internal teams.

Patient Financial Support

• Educate patients regarding their financial responsibility and available payment options.

• Assist patients with financial hardship requests, payment plan inquiries, and account resolution options.

• Support collection efforts through proactive account review and patient outreach.

• Ensure patient interactions reflect company values and support a positive patient experience.

Documentation and Compliance

• Maintain accurate and complete documentation of all account research, patient interactions, and account adjustments.

• Adhere to HIPAA requirements and applicable payer regulations.

• Follow internal revenue cycle policies and patient financial procedures.

• Identify recurring billing issues and communicate trends to management.

Required Qualifications

• High school diploma or equivalent required.

• Two or more years of healthcare revenue cycle, medical billing, patient accounting, or insurance follow-up experience.

• Experience reviewing EOBs, ERAs, patient balances, and claim adjudication.

• Knowledge of commercial insurance, Medicare, Medicaid, and managed care plans.

• Strong understanding of patient financial responsibility, deductibles, copays, coinsurance, and coordination of benefits.

• Excellent customer service and conflict resolution skills.

• Strong analytical and problem-solving abilities.

• Proficiency with EHR, practice management systems, payer portals, and Microsoft Office applications.

Preferred Qualifications

• Behavioral health or mental health billing experience.

• Experience with patient billing escalations and complaint resolution.

• Experience performing insurance verification and eligibility reviews.

• Familiarity with InSync, Collectly, payer portals, and clearinghouse systems.

• CRCR, CPB, CPC, or other healthcare revenue cycle certification preferred but not required.

Key Competencies

Competency

What Success Looks Like

Patient Advocacy

Supports a clear, respectful, and helpful patient financial experience.

Account Research and Analysis

Reviews account details, claim history, payments, adjustments, and documentation to validate balances.

Insurance Knowledge

Understands payer rules, eligibility, benefits, claim adjudication, and patient responsibility.

Claim Resolution

Identifies when claims need correction, rebilling, refiling, or additional payer follow-up.

Communication Skills

Explains billing outcomes clearly to patients and internal teams.

Attention to Detail

Maintains accurate documentation and catches discrepancies before they impact patients.

Performance Expectations

• Resolve patient billing escalations within established service-level goals.

• Maintain high account accuracy and documentation standards.

• Identify and correct patient balance discrepancies timely.

• Minimize inappropriate self-pay balances through proactive insurance review and claim refiling.

• Demonstrate professionalism and empathy during all patient interactions.

• Contribute to reduced patient complaints and an improved patient financial experience.