PFS Analyst

Inspire health. Serve with compassion. Be the difference.

Job Summary

Responsible and accountable for monitoring and/or resolution of high dollar high profile escalated accounts timely and accurate posting adjustments correspondence and/or denials resulting in significant exposure to Prisma Health. Work accounts ensuring complete accurate and compliant processes resulting in optimal collection and customer service performance for the organization. Work on various special projects as assigned to ensure billing AR and denial prevention is optimal. Knowledge of payers and provides support to other team members as needed. Meets and exceeds the appropriate performance and productivity standards and key performance indications for the department. Demonstrates accurate and professional relationships with all Prisma Health patient accounts ancillary departments and third party payers in accordance with Prisma Health Service Excellence Standard of Behaviors and Compliance.

Accountabilities

• Monitors researches and/or resolves high dollar high profile and problem accounts providing necessary information to various internal revenue cycle departments clinical and corporate departments and patients for resolution of account inquiries. 25%
• Monitors reviews and provides analysis of all assigned work queues dashboards and watch lists payer communications and analysis identifying trends and working with other departments to resolve system issues. 15%
• Demonstrates superior communication skills necessary for developing and maintaining positive professional relationships with team members revenue cycle departments clinical and corporate departments payers and industry organizations. 15%
• Evaluates payer performance and payment trends to provide management with valuable statistics to facilitate improved payer relations and contracting criteria identifies payer specific problem trends and works with clinical departments outcomes management managed care reimbursement and PFS to rectify systematic issues. 10%
• Facilitates attends and/or participates in payer assigned meetings for improved payer relations and to identify and resolve payer processing claims and denial issues. Assures timely communication of all meeting outcomes to appropriate PFS team members. 10%
• Attends appropriate meetings and training seminars to assure awareness and understanding of all billing regulations compliance policies industry changes and/or payer reimbursement guidelines. Maintains professional growth and development through seminars workshops in-service meetings current literature and professional affiliations to keep abreast of latest trends in field of expertise.5%
• Recommends and assists in the development of regular training sessions with team members to ensure highest quality and productivity standards are achievable. Assists in on boarding of new team members as well as providing ongoing support for all FS team members. 5%
• Identifies payer specific trends and works with revenue cycle clinical and corporate departments managed care and reimbursement teams on resolution. 5%
• Maintains strict adherence to department quality measures and timely and accurate completion of assigned responsibilities.5%
• Responsible and accountable for reconciliation and accuracy of vendor invoices vendor staff set up in EPIC vendor collection and expense reports.5%

Supervisory/Management Responsibilities

This is a non-management job that will report to a supervisor manager director or executive.

Minimum Requirements

• High School diploma or equivalent
• 5 years -Health Care Revenue Cycle experience including registration billing collections credits refunds customer service banking finance or managed care.

Knowledge Skills or Abilities

• CRCA or CRCR - preferred

Work Shift

Day (United States of America)

Location

Patewood Outpt Ctr/Med Offices

Facility

7001 Corporate

Department

Patient Financial Services

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.