Patient Financial Services Representative

Completes assigned revenue cycle tasks. Assists in the completion of submitting electronic and/or manual insurance claims, resolves claim edits, performs insurance account follow-up, researches claim denials for resolution and submits disputes and appeals when necessary. Represents the System in a professional manner while interacting with peers, leaders, patients, and third-party payers to achieve timely payment on accounts in accordance with current government and payer regulations.

Full time (40 hours weekly)

Monday - Friday Dayshift

Completes assigned revenue cycle tasks. Assists in the completion of submitting electronic and/or manual insurance claims, resolves claim edits, performs insurance account follow-up, researches claim denials for resolution and submits disputes and appeals when necessary. Represents the System in a professional manner while interacting with peers, leaders, patients, and third-party payers to achieve timely payment on accounts in accordance with current government and payer regulations.

Essential Functions:

• Corrects financial and demographic information that has been inaccurately entered into Epic.
• Performs various functions to complete and expedite the billing process including:
• Reviews and submits Hospital and/or Physician claim forms (UB04, 1500, etc) to insurance companies via electronic or manual processes and facilitates special billing for split claims, ancillary charges, interim bills, etc.
• Resolves Claim edits to facilitate timely billing and reimbursement.
• Performs follow-up with insurance companies to obtain claim status, payment information and to resolve claim discrepancies.
• Submits itemized bills, medical records, and corrected claims as needed.
• Reviews remittance advice (835) to ensure proper reimbursement.
• Accesses external payer sites for payer policies, claim investigations, and claim disputes.
• Reviews accounts and coordinates with appropriate departments on accounts requiring precertification, preauthorization, referral forms and other requirements related to managed care.
• Makes written and/or verbal inquiries to third party payers to reconcile patient accounts. Follows up on accounts until zero balance or turned over for collection.
• Reviews third party payer payments and investigates accounts not paid as expected. Takes appropriate corrective action to include follow up, rebilling, and/or adjustment of contractual allowances.
• Answers all inquiries regarding patient accounts.

• Maintains appropriate records, reports, and files as required.
• Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards.
• Participates in educational programs and in-service meetings.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

• High School Diploma or GED Required

• 1 year Required

• Excellent communication and interpersonal skills
• Familiarity with payer rules and policies
• Familiarity with healthcare billing systems (Epic preferred)
• Familiarity with medical and billing terms to help interpret edit resolution, claims remittance advice, medical record documentation and payer medical/payment policies

• Comprehensive health benefits
• Flexible spending and health savings accounts
• Retirement savings plan
• Paid time off (PTO)
• Short-term disability
• Education assistance
• Financial education and support, including Daily Pay
• Wellness and Wellbeing programs
• Caregiver support via Wellthy
• Childcare referral service via Wellthy

Well Span Health’s vision is to…