Patient Financial Service Account Representative II

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.

Location

680 Lake Shore Drive

Job Description

A Patient Financial Service (PFS) Account Representative II (Follow-Up) 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 reimbursement is missing.

A Follow-Up representative is responsible for resolving unpaid or denied claims, underpayments/overpayments, obtaining claim responses from payers, and working payer correspondence to secure proper reimbursement that is owed. The Follow-Up representative will work within the Epic system to monitor accounts receivable (AR) and take necessary actions to reduce aged AR.   

This role plays a vital part in the revenue cycle by diagnosing the root cause of the unpaid claim and coordinating with internal departments (as needed) to resolve medical necessity, authorization, coverage and other issues. The Follow-up representative also ensures the hospital is complying with the payer’s medical/reimbursement policy and contractual agreements. 

Ultimately, the Follow-up representative is responsible for the timely and accurate resolution of hospital accounts and the collection of reimbursement to maintain hospital operations.  The success of a Follow-Up 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.

Essential Job Functions:

• Demonstrated mastery of all job functions of Patient Financial Service Account Representative I.

• Resolve unpaid or denied claims for Government entities, private insurance payers and families; consistent with Federal, State and insurance specific requirements.

• Diagnose reasons for underpaid/overpaid claims (e.g. contractual agreement discrepancies, incorrect payer plan loaded, incorrect Epic expected reimbursement calculation), and work with appropriate parties to resolve.

• Contact payers when claim is accepted but no responses/remittances are given timely.

• Address payer correspondence as needed.

• Ensure claims comply with payer-specific billing guidelines and regulations.

• Communicate and collaborate with Revenue Integrity, Case Management, Coding to resolve insurance disputes and denials.

• Identify recurring issues and works to understand root cause.  Escalate trends to management for process improvement and payer escalation.

• Utilize Epic’s real-time eligibility and payer tools to validate insurance data and benefits.

• Maintain documentation of all actions taken on accounts in accordance with department policies and standards.

• Meet productivity and quality standards as defined by department leadership.

• Routinely uses Epic, claims clearinghouse, office software, verbal and written skills to expedite billing of claims and resolution of issues.

• Other Job Functions as assigned.

Knowledge, Skills and Abilities:

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

• Minimum 1 year, 2 years preferred, 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.

• Minimum 1 year experience in Patient Financial Services Representative.

Education

High School Diploma/GED (Required)

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