Patient Financial Services Rep 4 - Medicaid Follow Up

Inova • Fairfax, VA

23h • Remote

About The Position

Inova Health – Medicaid Follow Up is looking for a dedicated Patient Financial Services Representative 4 to join our team. This role will be full-time – day shift from Monday - Friday, Business Hours. This is a Remote Role. Remote Eligibility: This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV The Patient Financial Services Representative 4 performs the duties of Patient Financial Services Representative 3 and is responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims. Processes claim for multiple payer types (i.e. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.) and ensures that all assigned claims meet clearinghouse and/or payer processing criteria. Ensures appropriate follow-up on assigned work lists while meeting all departmental productivity and quality review standards. Informs management of issues and potential resolutions regarding problems with the claims process. Provides support, education, and guidance to team members while performing duties, as assigned, in the absence of the supervisor or manager. Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Requirements

• Associate degree or an additional three years of experience appropriate to the position under consideration
• 3 years of Experience in revenue cycle, finance, customer service or data analytics
• Minimum of 5 years of experience in healthcare revenue cycle management, with a focus on Medicaid and Medicaid HMO claims.
• In-depth knowledge of Medicaid and Medicaid HMO policies, procedures, and regulations.
• Strong analytical skills to review and interpret complex claim data.
• Excellent communication and interpersonal skills for effective collaboration.
• Proficiency in using healthcare billing software and systems.
• Ability to work independently and manage a high volume of claims.
• Attention to detail and strong organizational skills.

Nice To Haves

• Medicaid Follow Up experience
• Expertise in Insurance Follow-Up Resolutions highly preferred.
• Payor portal experience
• Proficiency in hospital billing systems (e.g., Epic) and insurance verification portals.
• Extensive understanding of Medicaid, Medicare, commercial insurance, and self-pay policies.
• Familiarity with HIPAA regulations and hospital financial assistance programs.
• Ability to analyze patient accounts, identify discrepancies, and resolve billing or insurance issues effectively.
• A bachelor's degree in healthcare administration, business, or a related field is preferred.
• Certification in healthcare revenue cycle management or a related field is an asset.
• Experience in a healthcare setting, preferably in a hospital or large medical practice.

Responsibilities

• Ensures that all clean claims are submitted the day they are received, submitted via the appropriate medium, and with all required attachments.
• Serves in the place of the supervisor or manager in their absence.
• Resolves complex issues either through individual actions or by coordinating information/actions of other team members, Patient Accounts staff, other hospital departments, or at the payer level.
• Ensures that claims are reviewed, corrections are identified/made or resolutions are initiated within 24 hours from the date that claims are received.
• Identifies the need for and provides support/guidance to other team members to promote their efficiency and productivity.
• Handles complex and/or highest dollar accounts while providing appropriate follow-up based on established protocol or SRGs.
• Ensures appropriate and timely documentation of all account activity while appropriately handling all correspondence within 48 hours of receipt.
• Documents activity in HealthQuest and TRAC and ensures that documentation is professional, appropriate, accurately depicts actions performed, and is in accordance with departmental quality review standards.
• Works payer response reports and rejection reports while ensuring they meet departmental productivity and quality review standards.
• Maintains knowledge of payer requirements, UB-92 standards, system (Hospital, clearinghouse, payer) functionality, and hospital policies and procedures.
• Takes direction from management to resolve issues in addition to providing support, education, and guidance to team members.
• Performs duties, as assigned, in the absence of the supervisor or manager.
• May perform additional duties as assigned.
• Review and analyze Medicaid and Medicaid HMO claims for accuracy and completeness.
• Identify and resolve claim denials, ensuring timely payment.
• Communicate with insurance providers, patients, and healthcare professionals to gather necessary information for claim resolution.
• Stay updated on Medicaid and Medicaid HMO policies and guidelines to ensure compliance.
• Collaborate with the billing team to ensure accurate and timely billing practices.
• Maintain detailed records of claim status, denials, and resolutions.
• Provide excellent customer service to patients and healthcare providers, addressing their inquiries and concerns.
• Research and identify trends in claim denials to develop strategies for improvement.
• Assist in training and mentoring junior financial services representatives.
• Perform other related duties as assigned by the department manager.

Benefits

• medical, dental and vision coverage
• a robust team member wellness program
• Inova matches the first 5% of eligible contributions
• up to $5,250 per year in education assistance
• up to $10,000 for student loans
• 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• paid time off
• paid parental leave
• flexible work schedules

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree