Patient Financial Services Representative I - Days

WellSpan Health•Lewisburg, PA

10d

About The Position

Full time (40 hours weekly) Monday - Friday dayshift General Summary Completes assigned revenue cycle tasks. Assists in the completion of submitting electronic and/or manual insurance claims, resolves claim edits, performs insurance account follow-up, researches claim denials for resolution and submits disputes and appeals when necessary. Represents the System in a professional manner while interacting with peers, leaders, patients, and third-party payers to achieve timely payment on accounts in accordance with current government and payer regulations.

Requirements

High School Diploma or GED
1 year Required Work Experience
Excellent communication and interpersonal skills
Familiarity with payer rules and policies
Familiarity with healthcare billing systems (Epic preferred)
Familiarity with medical and billing terms to help interpret edit resolution, claims remittance advice, medical record documentation and payer medical/payment policies

Responsibilities

Corrects financial and demographic information that has been inaccurately entered into Epic.
Reviews and submits Hospital and/or Physician claim forms (UB04, 1500, etc) to insurance companies via electronic or manual processes and facilitates special billing for split claims, ancillary charges, interim bills, etc.
Resolves Claim edits to facilitate timely billing and reimbursement.
Performs follow-up with insurance companies to obtain claim status, payment information and to resolve claim discrepancies.
Submits itemized bills, medical records, and corrected claims as needed.
Reviews remittance advice (835) to ensure proper reimbursement.
Accesses external payer sites for payer policies, claim investigations, and claim disputes.
Reviews accounts and coordinates with appropriate departments on accounts requiring precertification, preauthorization, referral forms and other requirements related to managed care.
Makes written and/or verbal inquiries to third party payers to reconcile patient accounts.
Follows up on accounts until zero balance or turned over for collection.
Reviews third party payer payments and investigates accounts not paid as expected.
Takes appropriate corrective action to include follow up, rebilling, and/or adjustment of contractual allowances.
Answers all inquiries regarding patient accounts.
Maintains appropriate records, reports, and files as required.
Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards.
Participates in educational programs and in-service meetings.
Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.