Patient Financial Service Representative 3

As a Patient Financial Services Representative 3, you will perform the duties of a Patient Financial Services Representative 2 and be responsible for the timely and accurate editing, submission and/or follow-up of assigned claims. To help achieve our mission, you will process claims for at least two payer types (i.e. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.) and ensure that all assigned claims meet clearinghouse and/or payer processing criteria. Ensuring appropriate follow-up on assigned work lists while meeting all departmental productivity and quality review standards is of vital importance. Providing team management with issues regarding the claims follow-up process is expected. Ensuring that payer response reports and rejection reports are worked timely and meet departmental productivity and quality review standards is required.

Job Responsibilities

• Ensures that all clean claims are submitted the day they are received, submitted via the appropriate medium and with all required attachments. Reviews claims, identifies/makes corrections or initiates resolution within 24 hours of the date the claim was received.
• Documents and reports claims submission issues immediately and provides feedback to team management regarding issues and wins.
• Provides resolution for pending (WIP backlog) claims within allowable timeframes, as defined for appropriate deficiency, and/or provides appropriate account follow-up based on established protocol or SRGs.
• Completes write-off requests and submits to supervisor for daily review.
• Appropriately documents activity in HealthQuest and TRAC.
• Completes and submits all daily, weekly and monthly reports with minimal errors.
• Maintains knowledge of payer requirements, UB-04 standards and system (i.e. Hospital, clearinghouse, payer) functionality in addition to Hospital policies and procedures.
• Ensures documentation is professional, appropriate, accurately depicts actions performed and is in accordance with departmental quality review standards.

Additional Requirements

Education:

High School or GED

Experience:

Two years of experience in revenue cycle, finance, customer service or data analytics. Demonstrated ability to learn Revenue Cycle functions.

Skills:

• Knowledge of Microsoft Office products (Word, Excel, PowerPoint, Access) or equivalent software.
• Working typing and CRT skills.
• Working knowledge of patient accounting systems such as Epic.
• Ability to think critically and resolve accounts with minimal supervision.
• Working knowledge of Patient Accounting systems.