Patient Financial Services Representative

Job Overview

Requirements

• Must have a high school diploma, GED, or equivalent.
• Minimum of one to two years of experience with health insurance, collection techniques, or patient registration required.
• Proficiency with Microsoft Excel, including the ability to create daily and monthly logs and summary reports, insert simple formulas and manipulate the design and appearance of worksheets required.

Work Hours

We are seeking a full-time (40 hr/week) Patient Financial Services Representative to work Monday- Friday in our Business Office. Offers flexible hours between 6:00 AM and 5:00 PM.

Job Summary

The Patient Financial Services Representative serves as the primary liaison between patients and insurance companies. They ensure primary and secondary claims are submitted timely and received by insurance company. The PFS Representatives appeal claims appropriately, work to find root cause of denials, and think outside of the box to find solutions to payment problems. They are also familiar with payer guidelines/rules and are able to train other staff in correct practices by payer. The PFS Rep understands general contract guidelines by payer and can analyze credit balances to ensure accurate and timely refunding to appropriate parties. Additionally, they facilitate timely payment, identify overdue accounts, take required actions, and maintain complete and accurate patient accounting records. The PFS Rep is familiar with and assists patients in all facility programs designed to help resolve their balance in a timely manner. They accurately recommend accounts for collections and maintain high levels of customer satisfaction.

Essential Job Functions and Responsibilities

This list of duties and responsibilities is not all inclusive and may be expanded to include other duties and responsibilities as management may deem necessary from time to time.

1. Prepares claims for insurance submission, resolving edits and problems that prevent a claim from being submitted to payers.
2. Reviews and trends late charges.
3. Submits clean claims to all types of payers.
4. Ensures solid knowledge of billing rules, including those specific to contracted and government payers. Is prepared to educate hospital staff on these rules and work with IT to ensure that system is optimized to account for rules specific to each payer
5. Reviews denials, appealing when necessary and identifying and recommend solutions to root causes of denials.
6. Identifies trends in problems and appropriately addresses root cause to minimize future problems.
7. Interacts with patients, guarantors, physicians, attorneys, worker comp carriers, employers, and third party payers by telephone, mail, e-mail, internet, fax, or in person to establish customer billing satisfaction and to ensure prompt reimbursement for patient accounts.
8. Serves as the primary liaison between patients and insurance companies.
9. Regularly analyzes and processes credit balances, ensuring all credit balances are addressed timely.
10. Reviews and addresses any variances to payment outside contractual expectations.
11. Actively works with others to create efficiency in revenue cycle processes. Utilizes EHR and other tools and resources provided in order to accomplish this. Works toward a paperless office.
12. Prepares noninsurance claims for submission including monthly institutional claims and private pay statements.
13. Promptly checks status and resolves submission on claims when insurance has not responded in a timely manner.
14. Is familiar with and assists patients on all resources available to resolve outstanding accounts. This includes discounts, payment plans, collection, and community care.
15. Attends staff meetings and in service training sessions.
16. Adheres to Southwest Health’s value-based behavior standards.
17. Understands and adheres to Southwest Health compliance and HIPAA standards as they appear in the Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy.
18. Performs other duties and responsibilities as requested or required.

Contact Information

Southwest Health
Attn: Human Resources
1400 Eastside Rd
Platteville, WI 53818
Phone: (608) 342-0998
Email: hr@southwesthealth.org
Fax: (608) 342-5015

Benefits

Southwest Health is truly an outstanding place to work. A full benefit package is available for employees working 20 hours/week or greater which includes: Health, Dental, Vision and Life insurance. Also available are long and short term disability, cell phone discount, flexible spending plan, paid time off, retirement plan with an employer contribution, fitness membership discount as well as use of exercise equipment at the facility.