Patient Financial Service Coordinator - Reimbursement - FT - Day
About The Position
The Patient Financial Service Coordinator is a key member of the financial team, coordinating billing functions with employees who perform complex claim-submission tasks. The role supports accurate and timely submission of claims to appropriate third-party payors, compliance with laws and payer contracts, customer satisfaction, and cash flow. The coordinator identifies claims that fail billing edits and takes action to reduce those failures. The role also tracks and analyzes payment denials and underpaid claims, appeals claims to obtain payment, coordinates with clinical departments on medical-necessity appeals, and recommends process improvements to reduce denials. Work is performed in accordance with established policies and procedures and applicable Joint Commission, Medicare, payer contract, HIPAA, regulatory, and organizational Code of Conduct requirements. This position has no supervisory or budget responsibility and is not patient-facing. It is hybrid, with remote-work arrangements requiring a quiet, distraction-free workspace, reliable electricity and internet with at least 25 Mbps upload speed, focus on job duties during working hours, adherence to agreed break and attendance schedules, and compliance with Stormont Vail’s Remote Worker Policy and annual Remote Work Agreement. The position is full-time, 40 hours per week, on the first/day shift, with shifts under 12 hours. It is non-exempt.
Requirements
- High school diploma or GED.
- At least 2 years of experience in a clinical healthcare setting, such as a physician's office or hospital, in patient financial services, patient registration, patient scheduling, or related healthcare.
- Knowledge of major third-party billing and contract requirements.
- Ability to read, analyze, and interpret business periodicals, professional journals, technical procedures, and government regulations.
- Strong written and oral communication skills, including the ability to present information and respond to questions from management, physicians, employees, and the public.
- Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages, and apply basic algebra concepts.
Nice To Haves
- Bachelor's degree in business, accounting, finance, or a related field.
- Working knowledge of basic medical terminology and understanding of medical and clinical treatment processes.
- Keyboarding or typing skill of at least 30 words per minute.
Responsibilities
- Generate re-bills after resolving edits and resubmit claims to third-party payors.
- Identify missing or incorrect requirements on rejected claims, resolve them, or promptly forward them to appropriate staff.
- Complete manual billing for claims that cannot be submitted electronically.
- Resolve electronic claim-edit failures and claims generated with inaccurate information; work with the clearinghouse as needed to correct and comply with its edits.
- Write appeals to obtain payment, coordinate with clinical departments on medical-necessity appeals, and follow up with payers until issues are resolved, including appeals for underpaid claims.
- Identify and notify management about process or system problems that may cause payer payment errors; recommend programs, system updates, applications, and procedural changes to reduce denials and improve customer relations and operational efficiency.
- Analyze changes in billing rules, policies, and procedures, and communicate those changes to appropriate staff.
- Process customer concerns in compliance with organizational policies while protecting patient and employee rights and maintaining confidentiality.
- Collect data and prepare timely reports for monitoring departmental compliance and productivity standards.
- Review Medicare Administrative Contractor newsletters, payer correspondence, and trade subscriptions to stay informed about regulations, policies, and payment methodologies.
- Analyze third-party denials and underpaid claims, recommend process improvements, and confirm payer receipt of claims through acknowledgment reports or other means.
- Identify, develop, and implement revenue-cycle process improvements.
- Identify, obtain, and submit required insurance attachments, such as medical records and prior authorizations.
- Review hospital cards, interface charges, electronic charge sheets, and similar records for accuracy, resolving missing or incorrect information.
- Review and resolve unbilled encounter reports.
- Identify and correct recurring problems by working with third-party payors or referring issues to appropriate staff.
- Coordinate ongoing staff training and educational development with educational or training staff, based on identified and assessed staff needs.
- Act as a liaison among the team, other team leaders, PFS management, physicians, and other organizational departments.
- Coordinate team input to department management regarding departmental budget development, analysis, and maintenance, and statistical analysis such as work performance and quality-improvement projects.
- Comply with Stormont Vail Health policies, standards, mandatory training, and requirements; perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
