Patient Financial Services Representative III

ANCHORAGE NEIGHBORHOOD HEALTH CENTER INC•Anchorage, AK

1d•Onsite

About The Position

The Patient Financial Services Representative III (PFSR III) serves as a senior-level biller responsible for managing the highest complexity revenue cycle functions and driving advanced resolution strategies. This role focuses on high-level denial resolution, trend analysis, and the development of preventive and corrective solutions to improve overall revenue cycle performance. The PFSR III applies advanced knowledge of coding, payer requirements, contracts, and reimbursement methodologies to resolve complex, systemic, and high-risk billing issues. This includes handling high-dollar accounts, multi-layered denials, and issues requiring in-depth research or cross-functional collaboration. The PFSR III is expected to fully work assigned accounts to resolution using advanced workflows, critical thinking, and payer knowledge while maintaining accountability for accuracy and outcomes. This role identifies patterns, and root causes that impact reimbursement and contributes to solutions that reduce recurring issues, improve claim accuracy, and strengthen billing workflows. In addition, the PFSR III provides guidance and shares knowledge with team members as needed.

Requirements

Five or more years of experience in medical billing, patient financial services, or revenue cycle operations, or demonstrated advanced competency in managing complex accounts, resolving high-level denials, and navigating payer contracts and reimbursement structures.
High school diploma or equivalent required.
Advanced knowledge of ICD-10, CPT, HCPCS, NDC, and CDT coding structures and payer-specific requirements.
Strong understanding of payer contracts, reimbursement methodologies, and denial management at a systemic level.
Ability to perform root cause analysis and develop long-term solutions to recurring issues.
Advanced proficiency in reporting, data analysis, and financial reconciliation.
Strong critical thinking, problem-solving, and decision-making skills.
Ability to provide guidance and share knowledge effectively with staff across multiple experience levels.
Proficiency in billing systems, EHR platforms, and advanced Microsoft Office functions.
Strong communication and collaboration skills across departments.

Nice To Haves

Medical billing coursework preferred but not required.

Responsibilities

Work assigned accounts and responsibilities by applying advanced workflows, fully resolving complex and system-level items using available resources and collaboration when necessary.
Maintain accountability for assigned accounts and responsibilities while contributing to resolution of complex issues through collaboration when appropriate.
Independently manage and resolve high-complexity accounts across multiple service areas, including those involving multi-payer coordination, contractual discrepancies, or systemic issues.
Oversee and ensure accuracy of the full claim lifecycle for high-complexity accounts, including charge integrity, claim submission, payment application, and final resolution.
Research and resolve advanced denied and unpaid claims, including high-dollar accounts, complex appeals, and issues requiring escalation to payers or external entities.
Analyze payer responses, contracts, and reimbursement patterns to determine root causes of denials and payment discrepancies.
Develop, implement, and monitor corrective and preventive actions to reduce recurring billing errors and improve clean claim rates.
Validate and reconcile complex payment scenarios, ensuring accurate reimbursement in accordance with payer contracts and billing guidelines.
Ensure accurate interpretation and classification of denials and payer responses, supporting consistency in workflows and reporting.
Identify trends in denials, payments, and workflow inefficiencies; communicate findings and provide actionable recommendations to improve revenue cycle performance.
Generate, analyze, and interpret advanced reports, including insurance aging, claim holds, work-in-progress accounts, and reimbursement trends.
Collaborate with providers, coding staff, and other departments to address documentation gaps, improve charge capture, and ensure compliance with billing standards.
Resolve complex discrepancies related to charge capture, payment posting, and account reconciliation within assigned work, collaborating across departments as needed.
Ensure compliance with payer guidelines, contractual requirements, and billing regulations.
Resolve complex patient and payer inquiries within assigned work, collaborating as needed to ensure accurate outcomes and appropriate service recovery.
Maintain an expert-level understanding of evolving HIPAA regulations, payer policies, and industry standards.
Provide guidance and share knowledge with PFSR I and II staff during daily operations.
Collaborate with leadership to identify opportunities for process improvement and operational efficiency.
Assist in developing training materials, workflow documentation, and best practices for the department.
Participate in team meetings, training sessions, and Continuous Quality Improvement (CQI) initiatives.
Support departmental operations as needed during high-volume periods or staffing gaps while maintaining accountability for assigned work.
Maintain a clean and orderly work area.
Perform other job-related duties as assigned.