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 and complex claim-submission work to ensure accurate, timely, and compliant claims; customer satisfaction; and maximized cash flow. The role identifies claims that fail internal or external billing edits and takes action to reduce edit failures. It also tracks and analyzes payment denials and underpaid claims from third-party payers, appeals claims to obtain payment, coordinates with clinical departments on medical-necessity appeals, and recommends process improvements to reduce denials. Work follows established policies and procedures and applicable Joint Commission, Medicare, payer contract, HIPAA, regulatory, and organizational Code of Conduct requirements. The position is full-time, first shift, with 40 hours per week. It is not patient-facing and has hybrid remote-work capability. Remote workspace requirements include a quiet, distraction-free environment that meets security and privacy standards, stable electricity, and internet with at least 25 Mbps upload speed. The employee must devote full attention to work and communication during working hours, follow agreed break and attendance schedules, and comply with Stormont Vail’s Remote Worker Policy and annual Remote Work Agreement acknowledgement. The role has no supervisory or budget responsibility.
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, relating to 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.
- Superior written and oral communication skills, including the ability to present information effectively 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.
- Ability to apply basic algebra concepts.
- Ability to meet remote-work requirements, including a quiet and distraction-free workspace, stable electricity, and internet with at least 25 Mbps upload speed; devote full attention during work hours; follow agreed break and attendance schedules; and comply with the Remote Worker Policy and annual Remote Work Agreement.
Nice To Haves
- Bachelor’s degree in business, accounting, finance, or a related field.
- Working knowledge of basic medical terminology.
- Understanding of medical and clinical treatment processes.
- Keyboarding or typing speed of at least 30 words per minute.
Responsibilities
- Generate re-bills after resolving edits and resubmit claims to third-party payers.
- Identify missing or incorrect requirements on rejected claims and resolve them or promptly refer them to appropriate staff.
- Complete manual billing for claims that cannot be submitted electronically.
- Identify and resolve electronic claim-edit failures, including working with the clearinghouse as needed to correct and comply with its edits.
- Identify and correct claims generated with inaccurate information.
- Write appeals to obtain payment, coordinate with clinical departments on medical-necessity appeals, and follow up with payers until issues are resolved.
- Write appeals to obtain payment on underpaid claims and analyze third-party underpaid claims.
- Identify potential process or system problems that cause payer payment errors and notify management.
- Recommend programs, system updates, applications, and procedural changes to reduce denials, improve customer relations, and increase operational efficiency.
- Analyze billing-rule, policy, and procedure changes and communicate them promptly to appropriate staff.
- Ensure customer concerns are handled in compliance with organizational policies while protecting patient and employee rights and confidentiality.
- Collect data and prepare timely reports to support monitoring of departmental compliance and productivity standards.
- Review Medicare Administrative Contractor newsletters, payer correspondence, and trade subscriptions to stay current on regulations, policies, and payment methodologies.
- Analyze third-party denials and recommend process improvements to reduce them.
- Confirm payers’ receipt of claims through acknowledgement reports or manually as required.
- Identify, develop, and implement improved revenue-cycle processes.
- Identify, obtain, and submit required insurance attachments, such as medical records and prior authorizations.
- Review hospital cards, interface charges, electronic charge sheets, and similar items for accuracy; resolve missing or incorrect information.
- Review and resolve unbilled encounter reports.
- Correct recurring problems promptly by working with third-party payers or referring issues to appropriate staff.
- Coordinate ongoing staff training and educational development with training staff by identifying and assessing staff needs.
- Serve as a liaison among the team, other team leaders, PFS management, physicians, and other organizational departments.
- Coordinate team input to department management concerning departmental budget development, analysis, and maintenance.
- Coordinate team input to department management concerning statistical analysis, work performance issues, 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
Education Level
High school or GED
