Patient Financial Services Representative I

General Summary

Completes assigned revenue cycle tasks. Assists in the completion of submitting electronic and/or manual insurance claims resolves claim edits performs insurance account follow-up researches claim denials for resolution and submits disputes and appeals when necessary. Represents the System in a professional manner while interacting with peers leaders patients and third-party payers to achieve timely payment on accounts in accordance with current government and payer regulations.

Shift

Part Time Part-time day shift 7-11am

Duties and Responsibilities

Essential Functions:

• Corrects financial and demographic information that has been inaccurately entered into Epic.
• Performs various functions to complete and expedite the billing process including: Reviews and submits Hospital and/or Physician claim forms (UB04 1500 etc) to insurance companies via electronic or manual processes and facilitates special billing for split claims ancillary charges interim bills etc. Resolves Claim edits to facilitate timely billing and reimbursement. Performs follow-up with insurance companies to obtain claim status payment information and to resolve claim discrepancies. Submits itemized bills medical records and corrected claims as needed. Reviews remittance advice (835) to ensure proper reimbursement. Accesses external payer sites for payer policies claim investigations and claim disputes.
• Reviews accounts and coordinates with appropriate departments on accounts requiring precertification preauthorization referral forms and other requirements related to managed care.
• Makes written and/or verbal inquiries to third party payers to reconcile patient accounts. Follows up on accounts until zero balance or turned over for collection.
• Reviews third party payer payments and investigates accounts not paid as expected. Takes appropriate corrective action to include follow up rebilling and/or adjustment of contractual allowances.
• Answers all inquiries regarding patient accounts.

Common Expectations:

• Maintains appropriate records reports and files as required.
• Maintains established policies and procedures objectives quality assessment safety environmental and infection control standards.
• Participates in educational programs and in-service meetings.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

• High School Diploma or GED Required

Work Experience:

• 1 year Required

Knowledge Skills and Abilities:

• Excellent communication and interpersonal skills
• Familiarity with payer rules and policies
• Familiarity with healthcare billing systems (Epic preferred)
• Familiarity with medical and billing terms to help interpret edit resolution claims remittance advice medical record documentation and payer medical/payment policies

Benefits Offered:

• Comprehensive health benefits
• Flexible spending and health savings accounts
• Retirement savings plan
• Paid time off (PTO)
• Short-term disability
• Education assistance
• Financial education and support including DailyPay
• Wellness and Wellbeing programs
• Caregiversupport via Wellthy
• Childcare referral service via Wellthy