PFS Revenue Specialist

Job Title

PFS Revenue Specialist

Renton, WA

$23.80 - $34.52 per hour (DOE)

Responsible for reviewing and managing high dollar balances, facilitating completion of patient forms, and handling appeals and denial resolution for UB and HCFA claims.

• Review pre-determined balance threshold accounts for UB and HCFA claims.
• Perform timely and accurate follow‑up of all high dollar outstanding balances (> $20,000 hospital, > $1,500 professional).
• Complete high dollar report and facilitate bi‑weekly high dollar meeting with PFS Leadership.
• Conduct field visits to complete patient forms requested by insurance payers.
• File liens to secure funds on pending TPL claim settlements.
• Handle work queues related to newborn eligibility and update policy information.
• Research denied claims to determine steps and draft appeal letters; interact with department personnel, third‑party payers, attorneys, and patients.
• Maintain knowledge of state and payer requirements; report payor changes to Manager as appropriate.
• Review Explanation of Benefits (EOBs) and vouchers to pursue payment of claims.
• Ensure accounts are reimbursed properly by contacting insurance companies to secure and expedite payments through follow‑up and appeals resolution processes.
• Understand and adhere to all federal, state, and local payer‑billing requirements.
• Contact insurance companies, third parties, patients, physicians, and departmental staff to obtain missing information.
• Identify, analyze, and resolve payment barriers.
• Communicate content deficiencies or contracting issues to Leadership.
• Return all phone calls within 24 hours of receipt.
• Cross‑train for other related business office functions to ensure smooth operation of the department.
• Maintain a consistent level of production within department standards.
• Facilitate proper escalation of accounts and patients' concerns when necessary.

• High school graduate or equivalent (GED); post‑high school college or training preferred.
• Three or more years experience in the health care industry required.
• Three years in customer service required.
• Experience managing receivables with high dollar balances ($20,000+); follow‑up, billing, appeals, and denial resolution required.
• Experience handling both hospital and professional claims preferred.
• Data entry skills and intermediate knowledge of Excel, Word, and Outlook required.
• Experience with denial resolution of various financial classes preferred.
• Experience in community outreach, including visits to patient's home or place of business required.
• Experience filing documents with state and federal agencies preferred.
• Prior experience with Epic, Epic Rim, and Chart Maxx preferred.
• Valid driver’s license and driving record with no moving violations required.
• Access to a working vehicle required for field visits.
• Excellent organizational and time‑management skills.
• Flexible, adaptable, and able to effectively cope with change.
• Demonstrates skills in typing and use of personal computers.
• Experience analyzing EOBs from various insurance companies/payers.
• Excellent customer service skills; communicate with confidence, tact, poise, courtesy, respect, and compassion.
• Effective communication and interpersonal skills within a diverse population.
• Demonstrate ability to communicate effectively in English, including verbally and in writing; spell accurately and write legibly.
• Practice active listening and use a variety of questioning techniques.
• Demonstrate ability to convey information fluently, interpret and clarify details, and explain rationale.
• Able to prioritize tasks, carry out assignments independently and within a team.
• Demonstrate a commitment to organizational values by displaying a professional attitude and appropriate conduct in all situations.