Patient Financial Services Representative

Full time (40 hours weekly)
Monday-Friday dayshift

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.

Duties and Responsibilities

Essential Functions:

• Conducts timely follow-up on patient accounts billed to insurance companies to determine reasons for delayed or missing payments.
• Investigates denied or rejected claims reviews insurance remittance advice and identifies reasons for denial.
• Collaborates with insurance carriers internal billing teams and other stakeholders to obtain necessary information and documentation to resolve claims.
• Documents findings and actions taken to resolve denials or delays in payment.
• Initiates and manages appeals or resubmissions of denied claims as appropriate.
• Communicates effectively verbally and in writing directly with payors to follow up on outstanding claims files technical and clinical appeals. Resolves payment delays/non-payments to ensure timely and accurate reimbursement.
• Maintains accurate records of follow-up activities and payment status in the billing system.
• Identifies trends in denied claims and recommends process improvements to reduce denials and expedite payment.
• Provides excellent customer service to patients and internal teams regarding billing inquiries and insurance follow-up.

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
• Associates Degree Preferred

Work Experience:

• 1 year Required
• Prior experience in hospital billing professional billing or insurance follow-up/denials Preferred

Knowledge Skills and Abilities:

• Knowledge of insurance claims processing payer policies and medical terminology is essential
• Strong analytical and problem-solving skills to investigate and resolve billing discrepancies
• Excellent verbal and written communication skills for effective interaction with insurance companies and internal teams
• Proficiency with billing software and Microsoft Office Suite (Excel Word Outlook)
• Ability to manage multiple accounts and prioritize tasks efficiently in a fast-paced environment
• Attention to detail and commitment to accuracy

Benefits Offered:

• Comprehensive health benefits
• Retirement savings plan
• Paid time off (PTO)
• Education assistance
• Financial education and support including DailyPay
• Expanded Paid Parental Leave

For additional details:Benefits & Incentives WellSpan Careers ()