Patient Financial Services Representative

Position Summary

The Patient Financial Services Representative supports hospital revenue cycle operations by performing patient billing insurance follow-up and financial counseling activities. This role ensures timely and accurate reimbursement for hospital services while providing a positive patient-centered financial experience.

The representative works closely with patients clinical departments and payers to support Medicaid eligibility billing and financial assistance programs helping ensure access to care for diverse and underserved patient populations.

Key Responsibilities

Hospital Revenue Cycle Operations

Process inpatient and outpatient hospital billing including claim submission and follow-up

Perform payment posting adjustments and account reconciliation

Monitor assigned hospital accounts receivable and follow up on unpaid or underpaid claims

Investigate and resolve claim denials coding issues and billing discrepancies

Ensure timely account resolution in accordance with hospital billing guidelines

Medicaid & Insurance Support

Verify insurance coverage and Medicaid eligibility for hospital patients

Assist with Medicaid enrollment applications and redeterminations for admitted and outpatient patients

Submit and track Medicaid and third-party claims including corrections and appeals

Identify denial trends and escalate issues impacting reimbursement

Patient Financial Counseling

Explain hospital billing processes insurance coverage and patient financial responsibility

Assist patients in applying for charity care financial assistance and presumptive eligibility programs

Collect required documentation and ensure completeness of applications

Set up payment plans in accordance with hospital policies

Customer Service

Respond to patient and guarantor inquiries regarding hospital bills and insurance claims

Provide clear compassionate communication especially in high-stress hospital situations

Resolve routine issues and escalate complex cases to supervisors

Compliance & Documentation

Maintain compliance with hospital policies HIPAA and federal/state regulations

Ensure accurate and complete documentation in hospital billing systems

Support audit activities by maintaining proper records and following internal controls

Collaboration

Coordinate with patient access registration case management utilization review and clinical departments

Communicate with insurance companies and Medicaid representatives to resolve account issues

Support discharge planning by addressing financial clearance and eligibility needs

Qualifications

Education

High school diploma or equivalent required

Associates or bachelors degree in healthcare administration Business or related field preferred

Experience

13 years of experience in hospital patient financial services billing or revenue cycle operations

Experience with inpatient and outpatient hospital billing preferred

Familiarity with Medicaid eligibility and hospital-based financial assistance programs

Skills

Knowledge of hospital billing systems and electronic health records (EHR)

Strong understanding of insurance processes including Medicaid and Medicare

Excellent customer service and communication skills in a healthcare environment

Ability to manage multiple accounts and meet productivity standards

Attention to detail accuracy and problem-solving abilities

Ability to work in a fast-paced hospital setting

Required Experience:

Unclear Seniority