PFS Revenue Cycle Representative

Company Description

At Lucile Packard Children’s Hospital Stanford, we know world-renowned care begins with world-class caring. That's why we combine advanced technologies and breakthrough discoveries with family-centered care. It's why we provide our caregivers with continuing education and state-of-the-art facilities, like the newly remodeled Lucile Packard Children's Hospital Stanford. And it's why we need caring, committed people on our team - like you.

Join us on our mission to heal humanity, one child and family at a time.

Job : LP_

This paragraph summarizes the general nature, level and purpose of the job.

The PFS Revenue Cycle Representative is responsible for the timely and accurate processing of patient accounts receivable collections. The specific job duties will be comprised of a combination of responsibilities from among the various areas of PFS operations including Accounts Receivable collections and payer follow-up, Payer denial review and appeals processing, Customer service, Payment applications, Credit balance review and resolution and Patient advocacy and risk management.

The position is an expert-level position with a superior background in hospital patient accounting and an extensive knowledge of reimbursement requirements of healthcare payers. The PFS Revenue Cycle Representative will act as a key resource for the team management in problem solving difficult issues and analyzing difficult accounts.

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.

Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.

Must perform all duties and responsibilities in accordance with the hospital's policies and procedures, including its Service Standards and its Code of Conduct.

• Review and correct all billable claims in billing software in accordance with payor specific guidelines and billing requirements within one working day.
• Work with HIM and applicable departments to resolve questions related to modifiers, orphan CPT/HCPCS codes, charge entry errors, ICD-9 and CPT/HCPCS coding errors, and other questionable claim form elements such as discharge disposition.
• Perform timely and appropriate follow-up to resolve unbillable claims. Using Interpoint, document in account notes all reasons for billing delays and actions taken. Apply the appropriate hold reason code in billing software.
• Process secondary billing in accordance with department procedures.
• Every time an account is accessed, review and correct all account discrepancies, update demographics and other field values such as mnemonic, insurance and billing information, etc., to ensure data integrity in Cerner/Meditech as well as in the billing software.
• Review all high dollar claims for potential stop-loss criteria and direct stop-loss claims to correct payor processing unit.
• Prepare and submit appropriate billing attachments as required by specific payors.
• Mail paper claims to appropriate payors.
• Review daily claim rejection reports, resolve rejection issues, and resubmit corrected claims to ACS within 24 hours of rejection.
• Collaborate with manager to resolve claim submission delays exceeding five working days.
• Inform manager of recurring claim errors in order to facilitate system improvements.
• Review and resolve non-covered charges according to facility procedures.
• Review late charge report. Submit late charge or adjustment claims, or write off late charges as appropriate per facility procedures.
• Review assigned Interpoint work lists to ensure appropriate…