PFS Rep Home Health, Full time Days

Join aworld-class academichealthcare system Ingalls Memorial Hospital as a Patient Financial Services Representative for our Home Health team in the Medicare and Commercial-BurrRidge Department. This is a remote work from home opportunity and you may be based outside of the greater Chicagoland area.

The Patient Financial Services Representative (PFS Representative) will be responsible for the account receivables management for Ingalls Memorial Hospital. This position requires detailed analysis and critical thinking to determine what is necessary to ensure timely and efficient resolution of an account. This position promotes revenue integrity and accurate reimbursement for the organization by enduring timely and accurate billing and collection of accounts. Maintains and monitors integrity of the claim development and submission process. Acts as a liaison between patients providers and payers for all post-care matters related to account resolution. The PFS Representative maintains an understanding of federal and state regulations as well as requirements specific to Medicare Medicaid and fiscal intermediaries to promote compliant claims for governmental claims. Maintains third-party payer relationships including responding to inquiries complaints and other correspondence. Additionally this individual must follow departmental productivity and quality control measures that support the organizations operational goals. All PFS representatives will participate in process improvement and cross-training activities on an ongoing basis.

Essential Job Functions

• Follows best practices in all patient financial services activities.
• Utilizes tools and work queues to identify and prioritize work.
• Demonstrates teamwork and integrity in all work-related activities to continually improve services and engage in process improvement activities.
• Documents all patient accounts activities concisely including future steps needed for resolution.
  
• Complies with state and federal regulations accreditation/compliance requirements and the Hospitals policies including those regarding fraud and abuse confidentiality and HIPAA.
• Performs billing and follow-up activities for claims.
• Works daily electronic billing file and submits insurance claims to third-party payers.
• Documents billing activity on the patient accounts; ensures Hospital compliance with all state and federal billing regulations and reports any suspected compliance issues to the appropriate supervisor.
• Reviews daily edit reports from the billing system
• Prepares and submits manual insurance claims to third-party payers who do not accept electronic claims or who require special handling.
• Contacts third-party payers to determine reasons for outstanding claims and communications with payers to facilitate timely payment of claims.
• Investigates any overpayments and underpayments and Medicare bad debt reporting policies in compliance with the Centers for Medicare & Medicaid Services (CMS) guidelines.
• Serves as the hospitals primary contact for all patient billing inquiries. Accepts inbound phone calls from patients physician offices and insurance carriers.
• Collects patient payments and follows levels of authority for posting adjustments refunds and contractual allowances. Assist patients in understanding billing statements to ensure swift resolution.
• Reviews and processes financial assistance requests documents approval/denials.
• Accurately post payments and adjustment resolve credit balances and monitor trends and compile reports for leadership among other duties.
• Prepares posts and processes payment batches; posts denials contractual adjustments and guarantor payments within payment batches; and ensures all payments batches are balanced.
• Reconciles bank deposit and patient accounts.
• Investigates the source of unidentified payments to ensure they are applied to appropriate accounts.
• Analyzes EOB information including co-pays deductibles co-insurance contractual adjustments denials and more to verify accuracy of patient balances.
• Reconciles EOBs to make necessary adjustments.
• Determines reason for credit balances and is responsible for accurate completion and resolution of potential credit balances for health plan payers and patients/guarantors.
• Identifies and examines underpayments/unapplied credits to determine if additional payment can be pursued or if refund is necessary; follows up with payers and patients as appropriate.
• Generates refund requests and routes the resolution to accounts payable for patients and third party payers; refunds overpayments and/or transfers payments to the appropriate account/accounts. Responsible for correcting errors in the calculation and posting of insurance contractual adjustments

Required Qualifications

• High school graduate or equivalent
• Preferred 3-5 years of home health and/or hospice insurance billing insurance follow-up insurance denials and/or insurance payment posting experience
• Understanding of the different insurance claim types in home health and/or hospice to include hospice per diem private duty nursing and home health PDGM
• Knowledge of the Notification of Admission (NOA) process that has taken the place of the previous Request for Anticipated Payment (RAP) workflows in home health
• Understanding of the Centers for Medicare and Medicaid (CMS) Outcome and Assessment Information Set (OASIS) process
• Excellent critical thinking and analytical skills
• Superior communication organizational and analytical skills
• Strong interpersonal and customer service skills
• Ability to multitask and work in a fast-paced environment
• Ability to prioritize tasks carry out assignments independently and within a team and to practice good judgment

Preferred Qualifications

• Associate degree in business healthcare or related field required or a combination of relevant education and experience
• Medical Terminology
• Proficiency in Microsoft computer programs
• Experience with Epic/Sorian

Position Details

• Job Type: Full Time (1.0FTE)
• Shift: Days: Monday-Friday (Remote)
• Department: Finance - Revenue Cycle
• CBA Code: Non-Union

For nearly a century Ingalls Memorial has pioneered sophisticated clinical care and developed the areas most convenient network of comprehensive outpatient centers all dedicated to improving the health and wellbeing of the community. Now partnered with UChicago Medicine we have expanded our network of expert physicians convenient facilities and scope of service to speed your healing process and help navigate your path to wellness. A skilled Medical Staff and talented employees dedicated to prevention diagnosis treatment and rehabilitation of illness and injury provide a firm foundation for our reputation for quality. To accomplish this we need employees with passion talent and commitment with patients and with each other. Were in this together: working to advance medical innovation serve the health needs of the community and move our collective knowledge forward. If youd like to add enriching human life to your profile UChicago Medicine Ingalls Memorial is for you. Here at Ingalls were doing work that really matters. Join us!

UChicago Medicine Ingalls Memorial is growing; discover how you can be a part of this pursuit of excellence at:Ingalls Career Opportunities

UChicago Medicine Ingalls is an equal opportunity employer. We evaluate qualified applicants without regard to race color ethnicity ancestry sex sexual orientation gender identity marital status civil union status parental status religion national origin age disability veteran status and other legally protected characteristics.

As a condition of employment all employees are required to complete a pre-employment physical background check drug screening and comply with the flu vaccination requirements prior to hire. Medical and religious exemptions will be considered for flu vaccination consistent with applicable law.

Compensation & Benefits Overview

UChicago Medicine is committed to transparency in compensation and benefits. The pay range provided reflects the anticipated wage or salary reasonably expected to be offered for the position.

The pay range is based on a full-time equivalent (1.0 FTE) and is reflective of current market data reviewed on an annual basis. Compensation offered at the time of hire will vary based on candidate qualifications and experience and organizational considerations such as internal equity. Pay ranges for employees subject to Collective Bargaining Agreements are negotiated by the medical center and their respective union.

Review the full complement of benefit options for eligible roles at Benefits - UChicago Medicine.