Patient Financial Services Representative

Southwest Health • Platteville, WI

2d

About The Position

The Patient Financial Services Representative serves as the primary liaison between patients and insurance companies, ensuring primary and secondary claims are submitted promptly and received by insurers. The representative appeals claims as appropriate, investigates the root causes of denials, and develops solutions to payment problems. The role requires familiarity with payer guidelines and general contract terms, and includes educating other staff about payer-specific practices. The representative analyzes credit balances to ensure accurate and timely refunds, facilitates prompt payment, identifies overdue accounts and takes appropriate action, and maintains complete and accurate patient accounting records. The role also helps patients use facility programs and resources to resolve balances and recommends accounts for collections while maintaining high customer satisfaction.

This is a full-time, 40-hour-per-week position in the Business Office, Monday through Friday, with flexible hours between 6:00 AM and 5:00 PM. Duties may be expanded as management deems necessary.

Requirements

• High school diploma, GED, or equivalent.
• One to two years of experience with health insurance, collection techniques, or patient registration.
• Proficiency with Microsoft Excel, including creating daily and monthly logs and summary reports, inserting simple formulas, and adjusting worksheet design and appearance.

Responsibilities

• Prepare insurance claims for submission and resolve edits or other problems that prevent submission.
• Review and trend late charges and submit clean claims to all types of payers.
• Maintain knowledge of billing rules, including rules for contracted and government payers; educate hospital staff and work with IT to optimize systems for payer-specific rules.
• Review denials, appeal claims when necessary, identify root causes, and recommend solutions to reduce future denials.
• Identify trends in billing problems and address their root causes.
• Interact with patients, guarantors, physicians, attorneys, workers’ compensation carriers, employers, and third-party payers through available communication channels to support billing satisfaction and prompt reimbursement.
• Serve as the primary liaison between patients and insurance companies.
• Analyze and process credit balances promptly, and review and address payment variances outside contractual expectations.
• Work with others to improve revenue cycle efficiency and use EHR tools and other resources; contribute to a paperless office.
• Prepare noninsurance claims, including monthly institutional claims and private-pay statements.
• Check claim status promptly and resolve submission issues when insurers have not responded in a timely manner.
• Assist patients with resources for resolving outstanding accounts, including discounts, payment plans, collections, and community care.
• Attend staff meetings and in-service training sessions.
• Follow Southwest Health’s value-based behavior standards and comply with its compliance and HIPAA standards, including applicable policies and codes.
• Perform other duties and responsibilities as requested or required.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• Long- and short-term disability
• Cell phone discount
• Flexible spending plan
• Paid time off
• Retirement plan with an employer contribution
• Fitness membership discount
• Use of exercise equipment at the facility

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED