Patient Financial Services Representative

Description

Job title: Patient Financial Services Representative

Reports to: Controller

Status: Full Time

Benefit Eligible: Yes

The Patient Financial Services Representative performs a variety of routine and non-routine clerical/patient accounting functions in accordance with standard procedures in one or more of the following areas: patient accounting, accounts receivable, or hospital revenue cycle for the Cherry County Hospital and Clinic.

• Works daily electronic billing file and submits insurance claims to third-party payers
• This position is responsible for posting monies received from all payor types (including Medicare, Medicaid, Managed Care, HMO, PPO, and patient)
• Accurate billing of patient accounts, ensuring timely claim submission and reimbursement from various third- party payers and patients, ensuring proper account documentation in the facility's billing system, and pursuing follow-up efforts on aged accounts
• Reviews, evaluates, and forwards manual patient account statements to payers that do not accept electronic claims or that require special handling
• Documents billing activity on the patient account; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to CFO
• Reviews claims for accuracy and coordinates with ancillary departments as needed to provide information for audits and/or record reviews
• Based on electronic payers' error reports, makes appropriate corrections to optimize the electronic claims submission process
• Ensures payments and adjustments are accurately posted to patient accounts
• Ensures payments in correct computer log to assure accurate patient statements
• Responds to written/oral requests for itemized bill from any customer including patient, insurance company, and attorney
• Researches all patient and insurance refunds in accordance to best practice/benchmark for compliance
• Calls patients to collect on outstanding balances, collecting insurance information, or providing payment options
• Responds to patients inquiries regarding the status of insurance claims or balances due
• Visits patients in the Emergency Department or the hospital to obtain information for billing or provider Medicaid application
• Review outstanding patient balances prior to patients receiving elective services to secure appropriate payment arrangements and/or compliance with previously established payment arrangements
• Ensures timely resolution of credits by accurate and timely refunds to the appropriate entity(s) and patient(s), prepares daily deposit and control sheets
• Sorts the mail and is responsible for distribution to the appropriate area/person
• Obtains pre-authorizations for services/procedures when required by the patient’s payor
• Posts charges onto the patient account for supplies and services that were provided to the patient to ensure proper billing and reimbursement
• Various other reporting and miscellaneous reports relating to Revenue Cycle functionality, Accounts Payable or Timekeeping could be required
• Ensures the confidentiality of patients’ medical, personal, and financial records is maintained
• Knowledgeable of and committed to practicing Corporate Compliance policies and procedures
• Complies with Cherry County Hospital personnel policies
• Performs other duties as assigned by the supervisor

• Ability to type, operate business machines including computers, and complex telephone systems
• Verbally interact with a variety of individuals
• Read fine print on documents
• Access files in order or execute the proper handling of accounts receivable credit and collection
• Execute general office duties as necessary in a proper manner
• Ability to interact with utmost courtesy and tact
• Supremely capable of projecting a demeanor of warmth and welcome to any and all individuals who presents themselves to the business office
• Ability to maintain confidentiality of any and all hospital and patient affairs
• Ability to read, write, verify, utilize, understand, trace, tender, tabulate, systemize, submit, study, organize, sort, search, scan, process, post, participate, move, locate, investigate, formulate, examine, draft, correspond,…