TCHP PATIENT FINANCIAL SERVICES REPRESENTATIVE

The Christ Hospital Health Network•Norwood, OH

18d

About The Position

The Patient Financial Services Representative supports all aspects of the Revenue Cycle billing and collections process and is responsible for billing and collecting outstanding accounts receivable balances. The role researches and resolves unpaid claims, prepares appeals for rejected or denied claims, and posts patient and insurance-provider payments accurately and on time. It also involves auditing and reconciliation, reviewing patient encounter reports, entering medical charges to initiate claim submission, and processing credit-balance work queues. The representative determines whether claims should be written off, sent to collections, or refunded, while ensuring regulatory compliance and maximum reimbursement. The position serves as a resource for department service lines and other revenue-cycle staff and must maintain the confidentiality and security of patients’ personal, medical, and financial information.

Requirements

High school diploma or equivalent required.
At least 3 years of recent work experience interpreting payer contracts.
At least 3 years of recent work experience with professional and/or hospital reimbursement and billing compliance.
At least 3 years of recent work experience developing and maintaining third-party payer relationships.
At least 3 years of familiarity with Patient Financial Services processes for claim generation and submission, billing edits, payer processing requirements, and claim and medical-record audit procedures.
Windows-based PC skills and computer proficiency.
Advanced medical terminology and knowledge of ICD-10 and CPT/HCPCS coding systems.
Advanced EMR/billing-system knowledge.
Advanced claims-clearinghouse-system knowledge.
Advanced knowledge of payer billing requirements and claims-resolution processes.
Advanced knowledge of interpreting explanations of benefits (EOBs) and medical claim fields.
Advanced knowledge of the professional revenue cycle.

Nice To Haves

CRCR certification preferred.
Epic experience preferred.

Responsibilities

Resolve billing and reimbursement issues accurately and on time, provide customer service, and collect outstanding balances.
Work with third-party payors and intermediaries, following departmental procedures to pursue prompt payment of professional claims for assigned financial classes and meet benchmarks, performance measurements, and reporting requirements.
Collaborate with internal and external stakeholders to resolve issues relating to the assigned workgroup.
Work with other patient financial services areas to identify and resolve issues involving medical-claim billing and collections and patient and insurance-provider payment posting.
Research unpaid claims and prepare appeals for rejected or denied claims.
Post patient and insurance-provider payments manually and electronically; perform auditing and reconciliation reports.
Review patient encounter reports for accuracy and enter medical charges to initiate claim submissions, supporting regulatory compliance and maximum reimbursement.
Process credit-balance work queues, review account accuracy, and determine final claim status for write-offs, collections, or refunds.
Maintain confidentiality and safeguard patient personal, medical, and financial information.
May serve as a resource to FSR I staff and preceptor to new employees.
Perform other job-related duties and assignments as requested.