Medical Accounts Representative

San Diego, California, United States
Jan 17, 2021
Biotech Beach
Required Education
High School or equivalent
Position Type
Full time

Telephonically and electronically interfaces with internal and external parties to collect payment on Prometheus diagnostic billing accounts.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
  • Provides a high level of customer service telephonically and electronically to insurance companies, doctors offices, patients, direct bill accounts and internal sales staff to maximize reimbursement on accounts
  • Processes faxes, emails and mail, from patients, insurance companies, doctor's offices direct billed accounts and corrects diagnostic codes, files appeals or faxing lab reports as appropriate
  • Handles all correspondence from patients, insurance companies, doctor's offices, labs and hospitals and takes appropriate action.
  • Reviews EOB's for appropriate payments and adjustments
  • Performs soft collection duties telephonically with patients requesting payments and providing comfortable payment arrangements
  • Calls patient/doctor's/hospital's/lab's insurance companies regarding outstanding accounts
  • Files appeals with insurance companies to obtain correct payment
  • Provides information to 3rd parties regarding our tests
  • Supports diagnostic and non diagnostic programs as assigned
  • Navigates multiple medical billing and account receivable applications to ensure access to accounts

This job has no supervisory responsibilities


To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The individual must possess outstanding customer service skills. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Position generally requires a High school diploma or general education degree (GED) and 1 year's related experience in a medical billing customer service role; or completion of a medical vocational school. Should be familiar with accessing Medical Coding (CPT & Diagnostic Codes) and HIPPA rules and regulations. Should understand medical terminology, EOB's and CMS 1500's and insurance classifications such as HMO, PPO, Medicare and private insurances. Familiarity with insurance plans, third party administrators, and governmental rules and regulations preferred.


Must be fluent in both verbal and written English. Must have the ability to speak effectively in order to provide information and respond to questions from managers, employees, patients, and payor representatives. Must have the ability to read and comprehend simple instructions, correspondence, and memos. Ability to prepare routine appeals and effectively communicate electronically and via telephone. Ability to respond to patients in an empathetic and professional manner. Ability to effectively present information in one-on-one and small group situations with other employees of the organization.


Ability to add and subtract numbers, to multiply and divide with 10's and 100's and to compute percents and fractions. Ability to perform these operations using units of American currency.


Ability to recognize problems, collect relative data, establish facts, draw valid conclusions and take appropriate action under close supervision. Ability to understand and appreciate HIPPA rules and regulations regarding patient privacy.


None required.


The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit for extended periods of time in front of a computer monitor. The employee is required to use headphones for extended periods of time while handling phone calls. The employee is required to perform extensive data entry. The employee frequently is required to use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.


The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually quiet.

All qualified applicants are considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status or other protected class.