Lead Patient Financial Services Representative

Cherry County Hospital and Clinic•Valentine, NE

7d•Onsite

About The Position

The Patient Financial Services Representative performs a variety of routine and non-routine clerical/patient accounting functions in accordance with standard procedures in one or more of the following areas: patient accounting, accounts receivable, or hospital revenue cycle for the Cherry County Hospital and Clinic. This role also involves leading day-to-day operations of the department, delegating tasks, setting deadlines, setting clear team goals, participating in recruitment and selection, training new team members, monitoring accuracy and productivity, motivating and coaching team members, identifying training needs, resolving conflict, providing feedback for performance evaluations, serving as a role model, and fostering an open communication and inspiring team environment.

Requirements

High School diploma required.
1 to 3 years of customer service and/or business office experience, ideally in a medical setting preferred.
Prior experience and knowledge in the use of software packages such as Microsoft Excel, Word, and Windows.
Knowledge of collection laws, 3rd party reimbursement, and basic hospital accounting.

Nice To Haves

Experience in a medical setting.

Responsibilities

Works daily electronic billing file and submits insurance claims to third-party payers.
Posting monies received from all payor types (including Medicare, Medicaid, Managed Care, HMO, PPO, and patient).
Accurate billing of patient accounts, ensuring timely claim submission and reimbursement from various third-party payers and patients.
Ensuring proper account documentation in the facility's billing system, and pursuing follow-up efforts on aged accounts.
Reviews, evaluates, and forwards manual patient account statements to payers that do not accept electronic claims or that require special handling.
Documents billing activity on the patient account; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to CFO.
Reviews claims for accuracy and coordinates with ancillary departments as needed to provide information for audits and/or record reviews.
Based on electronic payers' error reports, makes appropriate corrections to optimize the electronic claims submission process.
Ensures payments and adjustments are accurately posted to patient accounts.
Ensures payments in correct computer log to assure accurate patient statements.
Responds to written/oral requests for itemized bill from any customer including patient, insurance company, and attorney.
Researches all patient and insurance refunds in accordance to best practice/benchmark for compliance.
Calls patients to collect on outstanding balances, collecting insurance information, or providing payment options.
Responds to patients inquiries regarding the status of insurance claims or balances due.
Visits patients in the Emergency Department or the hospital to obtain information for billing or provider Medicaid application.
Review outstanding patient balances prior to patients receiving elective services to secure appropriate payment arrangements and/or compliance with previously established payment arrangements.
Ensures timely resolution of credits by accurate and timely refunds to the appropriate entity(s) and patient(s), prepares daily deposit and control sheets.
Sorts the mail and is responsible for distribution to the appropriate area/person.
Obtains pre-authorizations for services/procedures when required by the patient’s payor.
Posts charges onto the patient account for supplies and services that were provided to the patient to ensure proper billing and reimbursement.
Various other reporting and miscellaneous reports relating to Revenue Cycle functionality, Accounts Payable or Timekeeping could be required.
Ensures the confidentiality of patients’ medical, personal, and financial records is maintained.
Knowledgeable of and committed to practicing Corporate Compliance policies and procedures.
Complies with Cherry County Hospital personnel policies.
Performs other duties as assigned by the supervisor.
Oversee day-to-day operations of department.
Delegate tasks and set deadlines.
Set clear team goals.
Participate in recruitment and selection of team members.
Train new team members and monitor their accuracy and productivity.
Motivate and coach team members.
Identify training needs and provide coaching.
Resolve conflict; escalating as appropriate.
Provides feedback regarding job performance for team performance evaluations.
Serve as an effective role model, supporting department and organization changes.
Foster an open communication culture and inspiring team environment.