Patient Financial Specialist ( WPRC)

Company Description

** This is an onsite, in person vacancy**

We are a group of providers united by our clinically integrated, high-performance network and shared belief that physician autonomy is key to improving healthcare. As a physician-led medical group, we provide the tools, talent, and technology that enable you to improve patient care and your practice’s economic outcomes. We remove administrative work to help you transition to and thrive in value-based care so you can focus on patients, not paperwork and policy.

Job Description

Overview of the Role:

The Patient Financial Specialist (PFS) is responsible for all communications with the patients regarding their insurance and/or account with Privia Medical Group, as well as, all communications with third party payers regarding benefits and/or payment of services.  They are responsible for performing any or all of the below mentioned duties as necessary based on the responsible parties involved.

Essential Job Duties:

• Contact the patient prior to the visit to obtain/update the patient's demographic and insurance information.  Enters/updates this information in POLCI.

• Contact the third party payer as needed to obtain required information pertaining to the patient's coverage for that visit.

• Obtain physician referral prior for office visit/procedure.

• Obtain all necessary verifications and referrals for Surgery accounts.  Collect deposits, deductibles and/or co-pays prior to their surgery.

• Complete router with all pertinent information.  This information should include but is not limited to the name of the third party payer, the type of coverage (HMO, PPO, POS, etc.), method of payment, co-pay, or out-of-pocket deductibles.

• Enter all information in the POLCI system insurance notes and when pertinent, denotes the Primary Care Physician and whether a referral is needed.

• Responds to patient’s requests regarding their account and explain Complete MD Solutions’ financial policy and procedures as needed.

• Work with patients to secure pre-payment sources or make other financial agreements prior to service/procedures.

• Process billing calls and questions and answers correspondence related to patient accounts.

• Assist in processing of insurance claims and resolving any coding or billing errors in order to maximize reimbursements and minimize patient liability.

• Assist patients in completing all necessary forms and/or supply medical documentation as necessary.

• Participate with other staff to seek account resolutions.

• Follow up on unpaid claims and resubmits.

• Follow up with third party payers regarding claims concerning non-payments, reductions, down coding, etc. and process appeals as necessary.

• Audit all patient account transactions for accuracy and resolve any outstanding issues.  Identify and correct billing errors.

• Communicates with clinical, hospital and physician personnel related to patient accounts and serves as primary problem solver.

• Initiate requests for patient payments by telephone or letter or use of collection letters.

• Audit all patient credit balance accounts for resolution.  Make all refunds promptly.

• Make recommendations concerning accounts to be written off and/or turned over for collection.

• Post all actions related to the patient's account into the computer system as a permanent record.

• Request specific, non-generated routers through the Router Control Support Clerk.

• Print “Daily Activity Report” at close of day to ensure charge/payment re-entry activities are balanced.

• Substitute for other PSR’s as needed.

• Participate in educational and developmental activities.

• Attend meetings as requested.

• Perform other duties as directed by the supervisor.

Qualifications

Minimum Qualifications:

• 4+ years of Appointment Secretary experience, preferably in a OB/GYN medical office setting

• 2+ years of PBX or call center experience 

• 2+ years of Athena EMR experience (Preferred)

• Basic computer literacy

• Ability to handle yourself in a professional manner

• Ability to accurately enter patient data into office software

• Be a self-motivator and problem solver

Minimum Qualifications:

• 2+ years of comprehensive experience in a medical/physician office environment.

• 2+ years of medical collections experience.

• 1+ year of working knowledge of CPT and ICD-10 coding standards.

• Athena EMR ex