Lead Patient Financial Services Representative

Job Overview

This lead position is responsible for supporting/assisting management in the billing and collection of accounts receivable for inpatient and outpatient accounts and/or resolving complex customer service issues. Assists manager in identifying edits in billing software/host applications to improve claim quality. Understands the revenue cycle and the importance of evaluating and securing all appropriate financial resources for patients to maximize reimbursement to the health system.

 

Contact for PFS Representatives 1 and 2 regarding questions/account issue resolution. Mentors and trains staff in the PFS Representative 1 and 2 positions. Maintains the best practice routine per department guidelines.

•  Billing reports worked daily, issues noted and follow-up with payers, patients or applicable departments completed in a timely manner per process.
• Daily work queues are at zero
• Correspondence worked daily
• Timely claims processing and timely appeals

Demonstrate a high degree of proficiency in billing and/or collection of multiple payers (both government and non-government) billing and collection practices.

• Works with multiple payer’s provider representative on issue resolution including claim resolution projects and process enhancements.
• May be expected to work in multiple systems and assist/mentor/train PFS Representative 1 and 2 staff in multiple systems.
• In conjunction with the department’s business analysts and PFS management, identifies billing system related issues and works on resolution/solution. May also assist the department’s business analysts and PFS management in user acceptance testing.
• Screens claims on-line or on paper for accuracy and obtain additional information for processing claims manually or via computerized system (EDI).
• Identify problem accounts and work towards timely resolution.
• Communicate daily via the telephone or written communication with payers, patients, departments to obtain and provide all information for payers to process and pay claims quickly and accurately.

 

Responsible for the analysis and processing of correspondence including rejections, requests for medical records, itemized bills, clarification of detail on bill, etc. Analyze paid claims for accuracy of payments and or rejections and properly account for payment and adjustments.

• Monitors accounts for timely follow-up and prompt resolution of denials or other complex account resolution.
• Assists in continuously improving the aging of receivables while minimizing controllable loss categories (i.e. Timely filing).
• Ensures that incoming call volumes are processed expeditiously.
• Ensures that incoming correspondence is processed expeditiously.
• Ensures that all written responses are clearly and professionally communicated.
• Notifies patient and/or guarantor of co-pays/deductible/coinsurance.
• Verifies insurance benefits to maximize reimbursement.
• Gathers data, summarizes, and prepares reports for management and completes special projects as assigned.
• Reconciles accounts receivable records with pending claim inventories for major payers.
• May assist in completing other functions within Patient Financial Services as necessary.
• Assists customers regarding billing questions and ensures appropriate resolution of problems. Explain and interpret eligibility rules and regulations or identify other resources available for financial assistance. Keep updated on changes with regulatory issues.
• Attends periodic meetings with payer representatives to discuss discrepancies and assist in developing action plan for correction

Required

• 2 years in an office clerical setting of which 1 year should be in a hospital or clinic business office.

Preferred

• 3 years’ experience in a hospital or clinic business office.

Benefit Overview

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link for additional information: https://www.fairview.org/careers/benefits/noncontract

Compensation Disclaimer

An individual's pay rate within the posted range may be determined by various factors, including skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization prioritizes pay equity and considers internal team equity when making any offer. Hiring at the maximum of the range is not typical.
EEO Statement

EEO/AA Employer/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status

Qualifications:

$23.61-$33.34 / Hourly

Salary : $24 - $33