01 Jun
Patient Account Representative- BCBS HMO
Alabama, Birmingham , 35201 Birmingham USA

OverviewGuidehouse is a leading global provider of consulting services to the public and commercial markets with broad capabilities in management, technology, and risk consulting. We help clients address their toughest challenges and navigate significant regulatory pressures with a focus on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that prepare our clients for future growth and success. The company has more than 10,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit: www.guidehouse.com. ResponsibilitiesThe Patient Account Representative is an extension of a client’s business office staff. Representatives are responsible for making outgoing calls to insurance companies to resolve account balances. All client policies and procedures are followed. Representatives will perform any and all job related duties as assigned. Summary for the position: Account Review and Follow-up


Complete all business related requests and correspondence from patients and insurance companies

Complete all assigned projects in a timely manner

Assist client and patients in all requested tasks

Communicate to Guidehouse management areas of concern or areas of improvement

Try to resolve account balances to zero prior to accounts being forwarded to an outside agency for collections

Job Description/Responsibilities:

Maintain AR <30.90% for aging greater than 90 days.

Ensure the integrity of quality follow up and maintain a quality review score of 2.82 or higher monthly.

Maintain productivity standard of 100% (6.25 accounts per hour).

Begin working Metrix task list immediately upon clocking in.

Implement the initial underpay process at the point of collection. It is the responsibility of each collector to calculate the expected reimbursement and identify any patient responsibility. With this information, the collector identifies and documents whether or not the claim has paid according to contract and verifies the balance on the account is correct. All information is to be documented clearly, concisely and completely in both Metrix and HealthQuest.

Continue follow-up efforts on all accounts worked, taking the appropriate action for the age and dollar amount of the account.

Streamline the denial process by ensuring clean claims and avoiding duplicate rebills.

Ensure all denials are adjusted using the correct code based on the root cause and for the dollar amount that we would have been paid.

It is the responsibility of each employee to communicate information, training opportunities, trends, issues, etc.

It is the responsibility of each employee to completely read and respond to all emails within a timely manner. General expectation is a response within the same day, even if the response is just an acknowledgment of receipt and that more research is needed.

It is the responsibility of each employee to listen and respond to all voicemails within a timely manner. General expectation is a response within the same day, even if that response is just an acknowledgment of receipt and that more research is needed.

It is the responsibility of each employee to complete all spreadsheets and reports timely and by the assigned deadline.

QualificationsRequired: High School Diploma or equivalent

1 year medical office (medical billing/collecting) experience.

Familiar with Microsoft Word and Excel


BCBS, Commercial Payers, Specialty Payers, VA, Transplant, Medicaid, Medicare Billing/Follow up and Denials experience

CPAR certification

Excellent problem solving and critical thinking skills

Additional RequirementsThe successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.

Due to our contractual requirements, to be eligible for this role, you must be fully COVID-19 vaccinated at time of hire.

DisclaimerAbout 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. Rewards and Benefits 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 and Adoption Assistance

401(k) Retirement Plan

Basic Life & Voluntary Life Insurance

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


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