PFS Specialist

Job Type: Regular

Time Type: Full time

Work Shift: Day (United States of America)

FLSA Status: Non-Exempt

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Under oversight of the Department Manager & Supervisor, the Patient Financial Services Specialist – Hospital Billing will be responsible for efficient & timely billing and collections of hospital outstanding balances on inpatient and outpatient accounts receivable of higher complexity within assigned work queues for a large multi-facility healthcare system with future expansion anticipated to maximize reimbursement to the health system.

Job Description:

· Utilizes the Epic Hospital Billing System to review and monitor accounts through the Billing, Denial, & Follow-Up work queues · Work assigned accounts with higher complexity (high dollars, specific denial records, etc) within Hospital Billing, Denial, & Follow Up various work queues while maintaining established productivity requirements.

· Contacts insurance carriers or other responsible parties to confirm payment dates, question why a claim was denied or questions why a claim was not processed for payment or denial.

· Performs all Hospital Billing, Follow-Up, and Denial activities necessary to obtain payment/resolution of claims.

· Review the entire account to ensure claims were billed properly, payments were applied correctly, and all necessary adjustments were made before moving to the next responsible party and/or adjusting balances and removing them from work queue(s).

· Gathers all necessary documentation needed to have claims reprocessed/adjudicated

· Informs and/or transfers to management of any problem accounts and or denial trends that require escalation within 2 days of identification

· Documents all actions taken within the EPIC account notes section and/or follow up/denial activities note sections.

· Adheres to all Hospital Billing, Follow up, and Denial departmental policies and procedures/training documents.

· Complete necessary training sessions required for the Hospital Billing system and demonstrate good working knowledge from those sessions to successfully resolve assigned accounts within Follow Up and Denial work queues

· Document all inactive periods and make them available upon management's request.

· Resolves accounts with higher complexity in any Claims Edit work queue and resubmits claims through the Epic Billing System.

· Works higher level of complexity specific claim edit work queue(s) daily and resubmit claims through the Epic billing system

· Works higher level of complexity External claim edits from Clearinghouse and resubmits claims through the Epic billing system

· Handles Paper claims processing including proper documentation of accounts with higher level of complexity

· Communicates all claims/data problems that cannot be handled to the Supervisor/Manager within one (1) day of identifying the problem.

· Identifies and researches all incomplete or inaccurate information on claims, demonstrates proper handling and escalation as needed.

· Handles payer 277 rejections on accounts with higher level of complexity and resubmits claims through Epic Billing system or other means of submission (i.e., email, fax, payer portal, certified mail) and provides trends to management for payer outreach and/or internal billing system updates to ensure timely filing and reimbursement

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more about this requirement.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled