Lead Patient Financial Services Representative

Cherry County Hospital•Valentine, NE

8d•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 involves overseeing day-to-day operations, delegating tasks, setting team goals, participating in recruitment, training, motivating, and coaching team members, resolving conflicts, and providing feedback on job performance. The ideal candidate is organized, detail-oriented, and enjoys working with people in a fast-paced healthcare 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

Ideally in a medical setting preferred

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
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