PFS Representative Billing and Collecting

PFS Representative Billing and Collecting

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The Patient Financial Services Representative supports the mission of providing quality healthcare to the patients of Whidbey Health by performing a variety of duties that support the financial health and well‑being of the organization. The PFS Representative may be responsible for coordinating patient referrals and subsequent follow‑up, verifying insurance and providing financial counseling to assist with self‑pay accounts, as well as billing and collection of insurance and self‑pay accounts.

This position is expected to demonstrate professional behavior, display appropriate conduct and show consideration, respect and patience toward all patients, families, staff and professional affiliates. The PFS Representative follows all federal, state and payer‑specific regulations and policies pertaining to documentation and billing practices to ensure all work is in compliance with established guidelines.

• Patient Referrals
  • Coordinate patients through referral and follow‑up care by scheduling with appropriate specialists, facilities, agencies and insurance companies.
  • Ensure that appropriate and timely follow‑up is provided to the patient, while documenting all patient referral information in a clear manner for staff.
  • Request appropriate copies of chart notes, laboratory results, radiology images, patient history and disseminate that information to the designated referral sources and monitor progress.
  • Provide updates to department staff when there are changes in referral procedures, laws and insurance requirements that would affect the patients’ care plan.
  • Work as an integral part of the care team, coordinating needs and patient progress with providers and other staff members to ensure a cohesive and seamless referral experience for the patient and their family.
  • Complete all forms according to department and governmental guidelines, scan documentation into the patient’s electronic medical record, and maintain a comprehensive filing system.
  • Provide backup support to the Patient Registrar or HIM Technician as needed.
• Insurance Verification
  • Contact insurance companies on preadmissions and admissions, verifying eligibility and benefits for patients.
  • Notify the Financial Advocate and/or service department or clinic of patients who do not have appropriate referrals and authorizations in place.
  • Document contact person name, eligibility, benefits, referrals, authorization, and any other pertinent information in notes.
  • Obtain patient signatures on Medicare and Tricare forms, maintain insurance notebook, and act as an insurance resource to other departments.
  • Review department schedules and identify patients not yet pre‑admitted for pending services; contact and interview patients by phone to obtain demographic and insurance information.
  • Provide backup support to the Patient Registrar or Financial Advocate as needed.
• Financial Advocacy
  • Interview and provide financial counseling to all patients regarding patient balances.
  • Arrange valid financial arrangements to resolve patient liabilities.
  • Assist patients in obtaining alternative financial resources such as bank loans, DSHS programs and financial assistance.
  • Identify patients for COBRA and ensure approval.
  • Obtain necessary release signatures and complete indicator reports on a timely basis.
  • Provide price quotes when requested by patients.
  • Provide backup support to the Insurance Verifier or Patient Registrar as needed.
• Billing and Collection
  • Electronically and manually bill all accounts timely, including insurance and self‑pay accounts.
  • Follow up on additional information requests from insurance companies within established productivity standards.
  • Contact patients or guarantors to collect on accounts, accept phone payments, process refunds, and promptly post payments through DDE and electronically.
  • Work closely with third‑party payers, collection agencies, and attorneys as needed, and articulate financial assistance policies.
  • Maintain daily queue and reports within productivity targets.
  • Review accounts and remittance to ensure correct payment,…