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Patient Financial Services Representative

South Shore Health
Weymouth, USA
Full-time
Mid
Onsite
$22.20 - $31.75
Discovered 3 days ago

Full Job Posting

Job Responsibilities:

  • Maintains up to date knowledge of all Federal, State and Insurance specific billing regulations, policies, procedures and code sets.
  • Notifies manager of any changes that would affect claim submission
  • Protect patient privacy and confidentiality in accordance with HIPAA regulations
  • Maintain compliance with federal, state, payer, and organizational billing regulations.
  • Monitor payer policy updates and communicate changes that may impact billing, collections, denials, or reimbursement processes.
  • Evaluates daily claim file using Claim Edit and Charge Review Work queues for submission of UB-04 and 1500 claim forms.
  • Initiate claim corrections as defined payer regulation and hospital policy.
  • Works external claim edits from Clearinghouse and resubmits claims through EPIC
  • Initiate collection of aged accounts receivable through Epic work queues while prioritizing accounts based on organizational goals and aging criteria.
  • Unresolved and incomplete accounts require insurance company contact by phone, e-mail or designated web site to resolve outstanding balances.
  • Collaborate with denial management staff for accounts that require clinical intervention for an appeal process.
  • Collaborate with clinical departments, patient access and other departments are needed to resolve account issues.
  • Generate technical appeals as needed for account resolution.
  • Provide to manager a detail account history for any account that is considered uncollectable.
  • Document all actions taken within the EPIC account notes section and/or follow up/denial activities note section. Documentation is required at least every 30 days for all accounts requiring follow-up.
  • Escalates payer related issues to Provider Representative for resolution and participate in monthly meetings.
  • Must maintain defined quality and productivity measures.
  • Evaluate current processes, identify denial or payment trends and escalate to Management.
  • Handle payer 277 rejections and resubmit through EPIC system.
  • Reconcile account balances and ensure appropriate adjustments are applied according to established policies.
  • Review credits work queues for resolution of overpayments and undistributed payments.
  • Review credit balances in assigned work queues and request refunds or payer retraction as needed.
  • Communicate with patients as needed for additional insurance or other information needed in order to process a claim.
  • Generate phone calls or letters as needed to obtain necessary insurance or other related information, prior to an account being placed in self-pay.
  • Obtain proper verification of predefined patient demographic information and maintain documentation in order to verify identity.
  • Embraces technological solutions to work processes and practices. Uses the Mytime payroll system to enter time worked, sick days, vacations and holidays.
  • Uses Epic functionality
  • Uses MS Outlook as a communication tool
  • Access provider web sites for verification of accounts.
  • Access SharePoint and OneDrive for stored files.
  • Fosters a “Culture of Safety” through personal ownership and commitment to a safe environment.
  • Successfully answers safety questions in the annual mandatory education packet.
  • Maintains a neat, organized work environment.
  • Adheres to respiratory etiquette guidelines.
  • Assist with identifying workflow improvements to enhance operational efficiency.
  • Assist leadership with special projects, audits, and process improvement initiatives.
  • Other duties as assigned by Managements in accordance with department needs.
  • Technology and Learning
  • Participates in continued learning and possess a willingness and ability to learn and utilize new technology and procedures that continue to develop in their role and throughout the organization.
  • Embraces technological advances that allow us to communicate information effectively and efficiently based on role.
  • Complete necessary training sessions required for the Billing System and assigned accounts within Follow Up and Denial work queues.
  • Job Requirements: Minimum Education High school graduate or above preferred Minimum Work Experience
  • 2 years of hospital and/or physicians billing preferred
  • Required Skills, Knowledge and Abilities:
  • Knowledge of healthcare billing, insurance plans, codes, and reimbursement methodologies
  • Proficiency in data entry and basic computer skills, including Microsoft Office Suite.
  • Excellent organizational and multitasking skills
  • Strong interpersonal and communication skills
  • Strong analytical and independent decision-making skills
  • Hybrid or remote work options may be available
  • Monday through Friday 8:00am - 4:30pm
  • Responsibilities if Required:
  • Education if Required:
  • License/Registration/Certification Requirements:
  • Embraces technological solutions to work processes and practices.
  • Uses the Mytime payroll system to enter time worked, sick days, vacations and holidays.

Qualifications

  • Minimum Education
  • Minimum Work Experience
  • Knowledge of healthcare billing, insurance plans, codes, and reimbursement methodologies
  • Proficiency in data entry and basic computer skills, including Microsoft Office Suite.
  • Excellent organizational and multitasking skills
  • Strong interpersonal and communication skills
  • Strong analytical and independent decision-making skills
  • Hybrid or remote work options may be available
  • Monday through Friday 8:00am - 4:30pm
  • License/Registration/Certification Requirements
  • Minimum Work

Preferred Qualifications

  • High school graduate or above preferred
  • 2 years of hospital and/or physicians billing preferred

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