Patient Financial Services Account Representative

Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked in all 10 specialties by the U.S. News & World Report.

Day (United States of America)

Location

680 Lake Shore Drive

Job Description

Job Summary:

A Patient Financial Service (PFS) Account Representative works as the last stop on the Revenue Cycle of the hospital. Therefore he/she holds all upstream areas (from our registrars to our clinicians to our coding team) accountable if a breakdown were to occur, or if pertinent information needed for billing is missing. A PFS representative is oftentimes the liaison between the hospital and the payer and is ultimately responsible for the reimbursement that is owed.  The success of a PFS representative directly impacts and correlates to the hospital’s bottom line and allows Lurie Children’s to fulfill our mission of serving children in need. Specifically, a PFS representative serves as the main contact for all patient/families, third parties, and related Lurie Children’s departments, analyzing and resolving all billing, collection, and customer inquiry needs.  Responsible for the timely and accurate resolution of hospital accounts and the collection of reimbursement to maintain hospital operations.  Routinely uses the patient accounting system, electronic claims systems, office software, verbal and written skills to expedite resolution of claims and issues.
 

Job Duties:

• Create and submit all billing to Government entities, private insurance payers and families; consistent with Federal, State and insurance specific requirements.

• Resolve all assigned claim edits generated by Epic, the clearinghouse or the payor. Develop strategy to reduce claim edits by collaborating with management and other departments.

• Identifies Registration, Demographic and Insurance information problems makes all necessary updates. This includes eligibility verification and referral retrieval.

• Resolve assigned denials and variances, accurately determining the root cause and collaborating to reduce the denial or variance.

• Ensure that all claims issued timely and are received by the payers.

• Process assigned inbound correspondence and telephone inquiries from patients and insurance carriers. Promptly responding in writing or verbally.  This includes researching and processing of charge revisions, corrections, adjustments, discounts associated with disputes. 

• Process internal payment transfers between Hospital and Patient Billing, process refund requests for families, governmental and third-party payors.

• Interacts with Health Information Management, Case Management on claim submission issues which can include obtaining the appropriate Medical Record, or validation of coding.

• Other job functions as assigned.

Knowledge, Skills, and Abilities:

• High school graduate required; BS, BA, or CHAA preferred.

• Minimum 6 months experience in healthcare, hospital, clinics, or physician office environment preferred.

• Knowledge of ICD-10 coding, medical terminology, third party billing and collections, and managed care requirements.

• Excellent communication/listening skills.

• Ability to make quick, accurate decisions on a daily basis.

• Ability to handle stressful situations.

• Proficient computer skills and aptitude, Microsoft Office mandatory, Advanced Excel preferred.

• Substantial interpersonal skills sufficient to work effectively with pediatric patients, families, physicians, nursing, other allied health professionals, insurance professionals and administration.

• Problem solving ability and able to handle multiple priorities.

• Thorough knowledge of patient accounting, third party payer procedures, governmental regulations and managed care contracting to be effectively proactive in the billing and collection process, and to respond to inquiries on patient accounts in a customer satisfaction manner.

Education

High School Diploma/GED (Required)

Pay Range

$19.50-$30.23 Hourly

At Lurie Children’s, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributi