Senior PFS Associate

Overview

Responsible for validation of insurance reported data. Ensure billing is according to state, federal, regulatory agency guidelines and hospital policy.  Review source documents as necessary. Validate and report any revised insurance information for primary and/or COB (coordination of benefits). Refer cases as applicable to governmental team and or commercial billing teams for handling as appropriate. Responsible for appeals processing for all denials received either through manual posting, correspondence, or 835 (electronic) recorded. Utilize all information systems to retrieve, verify and or appeal denied cases in payer web portal as appropriate.

Responsibilities

Review and analyze reports prepared by PFS department and follow up on unpaid claims. Send inquiries to insurers for complex cases, performing the necessary research, Review and analyze accounts with open balance after payment. Prepare and post a contractual allowance as required, rebilled, pended or denied accounts.

Serve as liaison to independent billing and/or collection agencies and provide information required.  Assist in the research and billing required responding to third party audits. Responsible for completing State     disenrollment forms for indemnity payers and or Manage Care plans, as required. Submit appeals according to Hospital procedure. Perform all billing, recording or related tasks as assigned by departmental management. Provide these services in an effective and efficient manner ensuring that all requirements are met in an accurate manner.

Qualifications

High School or GED required. Asscoaite Degree preferred. Proficiency with Excel spreadsheets to develop account reconciliation required.

Two (2) years of collection processing experience preferred

Experience with the maintenance of the patient file information

Experience in billing information systems

Experience in a Health Care environment preferred

Strong communication skills both verbal and written

Good analytics skills

Ability to multi-task and willingness to learn new skills

Ability to deal effectively with multiple information sources