Patient Financial Services Representative

Description

 SUMMARY: The Patient Financial Services Representative is responsible for the review of the patient financial information and the communication with the patient, and/or responsible party, of any third-party reimbursement coverage and/or the portion due from the patient for healthcare services. The Patient Financial Services Representative will complete a social and financial assessment and appropriately refer patients who have no insurance coverage or qualify for financial assistance to a medical eligibility agency for potential assistance through Federal, State, or local healthcare programs. The Patient Financial Services Representative will respond to all incoming financial related inquiries including billing, explaining EOB’s, fielding patient calls, applying adjustments, accepting proposals/negotiations. The Patient Financial Services Representative reports directly to the Patient Financial Services Supervisor.

Essential Duties and Responsibilities

Duties include but are not limited to:

• Reviews accounts to determine insurance coverage.
• Fields incoming calls and addresses all finance/billing related inquiries.
• Interviews the patient and/or responsible party to obtain any missing insurance information.
• Evaluate the need for financial assistance and discuss the patient’s financial responsibility.
• Responsible for the entry or update of insurance information on the patient’s account and assists in maintaining the insurance database.
• Refers account for insurance verification and benefit coverage to the Insurance Verification staff in a timely manner.
• Identifies patient with no third-party reimbursement and/or with financial assistance needs and communicates with the patient regarding potential sources for financial assistance.
• Makes timely referral to the medical eligibility agency to explore all available assistance and help in qualifying and filing for the eligible programs.
• Based upon the evaluation of ability to pay, collects from the patient or responsible party the patient portion, or establishes payment arrangements within the hospital guidelines.
• Properly documents all pertinent financial information and efforts in the account comments.
• Uses best judgment to resolve patient problems or refer issues to department supervisor.
• Remains current on knowledge of Medicare, Medicaid, Managed Care Contracts, and compliance regulations, as well as system and department processes. Complies with and supports department and organization policies and procedures.
• Responsible for the collection of payments or setting up payment plans prior to services being rendered, at time of admission, or during the discharge process.
• Seeks out relevant training or cross training from supervisor. Seeks out guidance from supervisor and teammates when uncertain of procedure. Solicits feedback from the supervisor to assess the quality and effectiveness of work. Participates in the dialogue process with supervisor regarding quality improvement. Demonstrates a personal commitment to continuous quality improvement through active participation.
• Other duties as assigned by Supervisor.

Minimum Qualifications

To perform this job successfully an individual must be able to perform each essential duty to a satisfactory standard. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education: High School Diploma required. An associate degree preferred.

Experience: Minimum of one (1) to three (3) years of experience working with patient accounting, insurance verification and precertification, financial counseling, and medical terminology is required. Previous experience in customer service, managing inbound calls, and patient collections within a healthcare setting is preferred.

Language Skills: Demonstrated ability to exercise professional oral and written communication skills with all internal and external audiences.

Computer Skills: Experience with medical billing software systems is required. Strong Microsoft Excel skills are required. Proficiency in Microsoft Outlook, Word, and PowerPoint is also required.

Reasoning Ability: Ability to organize and manage personal workload and the workload of assigned direct reports and associated teams. Ability to achieve and maintain strong working knowledge of anesthesia billing operation practices. Ability to analyze and assess the production effort of operations teams. Ability to work within an ambiguous, fast-moving environment,