Patient Financial Services Representative III

Fairview Health Services•St. Paul, MN

13d

About The Position

This position is responsible for billing and collecting accounts receivable for inpatient and outpatient accounts, ensuring expected payment is collected and accounts are fully resolved, and handling complex customer service issues. The representative evaluates and secures appropriate financial resources for patients to support proper adjudication and account resolution. The role includes processing and following up on patient requests, reviewing uninsured accounts and available payment sources, explaining patient liability, analyzing correspondence and paid claims, identifying problem accounts, and communicating with patients, departments, payers, collection agencies, and other vendors. It also involves managing bad-debt accounts, identifying patients with financial need, and working with the Department of Revenue’s Revenue Recapture Program in accordance with Minnesota requirements. The representative handles complex accounts and correspondence, works across multiple systems and workflows, supports process improvements, and may mentor staff or support the team lead. The position also requires compliance with applicable laws, regulations, payer requirements, and internal policies and standards.

Requirements

Two years in a medical billing office setting or relevant experience.
Organizational skills.
Communication skills.
Attention to detail.

Nice To Haves

Two years of medical billing office setting experience.
MS Office experience.
Coordination of benefits experience.
Experience with Epic, Brightree, Billing Bridge, or comparable account software.
Experience with medical terminology.
Experience with CPT-4 and ICD-10.
Extensive FV account review experience.
Extensive knowledge of FV system applications.
Extensive knowledge of FV revenue cycle management workflows.
Billing certification.
Substantial system super-user experience.
Ambulance billing, follow-up, verification, or coding experience.
Knowledge of ImageTrend Billing Bridge software.

Responsibilities

Resolve financial transactions appropriately and effectively to prevent untimely revenue shortfalls, escalating issues when appropriate.
Complete daily assignments accurately and on time in accordance with productivity and quality standards.
Follow department best-practice routines.
Identify and recommend continuous process improvements involving people and technology through tracking, trending, and feedback.
Seek single-touch resolution where possible to fully resolve accounts.
Evaluate and secure appropriate reimbursement from insurers or patients.
Contact payers through portals or provider service centers to resolve accounts accurately and promptly.
Process external correspondence efficiently and on time, and communicate and process internal correspondence professionally and promptly.
Verify insurance and/or patient demographic information.
Understand expected payment amounts and Epic expected-payment calculations, and adjust accounts appropriately.
Educate patients and guarantors about patient liability when appropriate.
Apply and comply with relevant laws, regulations, payer requirements, and internal policies, procedures, and standards.
Process accounts through multiple workflows, including accounts requiring additional attention to detail.
Make appropriate contacts with payers and other parties to obtain or provide information needed for accurate and timely account resolution.
Use multiple systems and applications, and knowledge of departmental functions and workflows, to facilitate collection and account resolution.
Investigate and resolve complex accounts in depth.
Use public-speaking skills in discussions and meeting facilitation.
Complete complex responsibilities or projects that may require senior leadership visibility or approval.
Mentor staff and/or support the team lead as a key team resource.
Analyze and process correspondence in detail to improve collection processes.
Maintain and share knowledge of relevant laws, regulations, payer and internal policies, procedures, and standards.
Provide support as needed using extensive knowledge of other areas within the department.
Process and follow up on patient requests involving payment research, charges, and insurance concerns.
Notify patients and guarantors of copayments, deductibles, and coinsurance, and independently resolve account questions with patients.
Review uninsured accounts, confirm applicable discounts, and explore available payment sources.
Bill and collect from multiple government and non-government payers; analyze correspondence, claims, explanation-of-benefits documents, payments, rejections, and adjustments.
Identify problem accounts and work toward timely resolution through communication with patients, departments, payers, and vendors.
Counsel patients on available account-resolution options and work with vendors and patients on reasonable resolutions.
Identify patients with financial need and work with collection agencies and the Department of Revenue’s Revenue Recapture Program, maintaining required documentation and following Minnesota guidelines.