Patient Financial Services Representative - Patient Financial Services - FT - Days

Position Status:

Full time

Shift:

First Shift (Days - Less than 12 hours per shift) (United States of America)

Hours per week:

40

Job Information
Exemption Status: Non-Exempt

A Brief Overview
Patient Financial Services Representative is responsible for ensuring efficient, accurate and timely processing patient accounts, uploading applications, service registration and final third- party payment account resolution after initial bill submission for automobile, workers compensation and liability patient accounts. These activities are completed following established policies and procedures, and in compliance with JCAHO, Medicare, Payer contracts, HIPAA, regulatory agencies and the organization's Code of Conduct.

Education Qualifications

• High School Diploma / GED Required
• Associate's Degree Preferred

Experience Qualifications

• 1 year Experience in healthcare financial services, patient registration, patient scheduling, or claims processing experience in the liability insurance field. Required

Skills and Abilities

• Excellent interpersonal and communication skills and the ability to exhibit patience.
• Detailed knowledge of major third-party billing and contract.
• Working knowledge of basic medical terminology.
• Ability to work productively as part of a team.
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or government regulations.
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages. Ability to apply concepts of basic Algebra.

What you will do

• Responsible for the processing of patient accounts after initial bill submission to final 3rd party payment resolution. This responsibility includes timely and accurate resolution of denied claims and insurance correspondence and follow-up on unpaid claims exceeding the clean claim payment cycle.
• Processes patient accounts from uploading into the clearinghouse application through final claim submission, both manual and electronic. This responsibility includes resolving remaining bill edit failures, claim submission, receipt reconciliation and rebilling when necessary.
• Collects, validates, and updates patient’s comprehensive data set and documenting in the registration system, completing electronic insurance verifications, identifying managed care issues and referring as appropriate for resolution, obtaining appropriate signatures to satisfy legal and health system requirements and completion of required forms including Medicare MSP.
• Identifies and notifies management of customer service issues and potential process/system problems that cause billing and payment errors and assists in improvement implementation as requested.
• Accurately and efficiently distributes and/or prepares various reports; processes account credit balances, refund requests, cash transfers, returned checks and unidentified payments in a timely manner.
• Accurately posts payments and adjustments and balances all entries according to payer cash processing and reconciliation procedures.
• Answers questions from other staff or clinic offices by phone or e-mail in a timely manner.
• Consistently and accurately documents accounts with activities as needed in a timely manner.
• Analyzes and resolves insurance correspondence for unpaid claims. Validates accuracy of insurance information and completed insurance verification for specific payors that do not participate in electronic eligibility by established procedures (phone calls, websites, etc.).
• Completes manual billing process for claims that cannot be sent electronically.
• Creates encounters for Physicians providing Hospital professional services including but not limited to ED professional fees, Hospital visits, Invasive procedures, Hospitalists, Radiologists, Therapies (including Chemo & Radiation), Counseling, etc.
• Generates re-bills after all edits have been resolved and re-submits claims to third-party payor. 
• Identifies and correctly resolves all electronic claim edits failures in a timely manner.
• Identifies missing or incorrect requirements of rejected claims and either resolves or forwards promptly to appropriate staff for resolution.
• Monitors and completes patient accounts on billing hold for additional informatio