Patient Financial Services Representative

South Shore Health•Weymouth, MA

2d•$22 - $32

About The Position

Patient Financial Services Representatives ensure the financial aspects of patient healthcare are handled efficiently and professionally. The role uses the Epic Billing System to prepare, submit, and follow up on compliant hospital and physician insurance claims, and communicates with insurance companies to resolve claim denials and discrepancies. The representative manages claim submissions, corrections, rejections, denials, and aged accounts receivable; researches and resolves account balances; documents follow-up activity; and coordinates with payer representatives, denial management staff, clinical departments, patient access, and other teams. The role also supports credit balance resolution, insurance information collection, process improvements, audits, and special projects. The position requires ongoing learning and use of billing technology and related systems. It is full-time, with a stated schedule of Monday through Friday, 8:00 a.m. to 4:30 p.m. Hybrid or remote work options may be available.

Requirements

High school graduate or above preferred.
Two years of hospital and/or physician billing experience preferred.
Knowledge of healthcare billing, insurance plans, codes, and reimbursement methodologies.
Proficiency in data entry and basic computer skills, including Microsoft Office Suite.
Excellent organizational and multitasking skills.
Strong interpersonal and communication skills.
Strong analytical and independent decision-making skills.

Nice To Haves

High school graduation or higher.
Two years of hospital and/or physician billing experience.

Responsibilities

Maintain current knowledge of federal, state, and insurance-specific billing regulations, policies, procedures, and code sets, and notify the manager of changes affecting claim submission.
Protect patient privacy and confidentiality in accordance with HIPAA and comply with applicable billing regulations.
Monitor payer policy updates and communicate changes that may affect billing, collections, denials, or reimbursement.
Evaluate daily claim files using Claim Edit and Charge Review work queues and submit UB-04 and 1500 claim forms.
Correct claims according to payer regulations and hospital policy, work external clearinghouse edits, and resubmit claims through Epic.
Handle payer 277 rejections and resubmit claims through Epic.
Initiate collection of aged accounts receivable through Epic work queues, prioritizing accounts according to organizational goals and aging criteria.
Contact insurance companies by phone, email, or designated websites to resolve unresolved or incomplete accounts and outstanding balances.
Collaborate with denial management staff when accounts require clinical intervention for appeals, and generate technical appeals as needed.
Collaborate with clinical departments, patient access, and other departments to resolve account issues.
Provide the manager with detailed account histories for accounts considered uncollectable.
Document actions in Epic account notes and/or follow-up or denial activity notes, at least every 30 days for accounts requiring follow-up.
Escalate payer-related issues to the Provider Representative and participate in monthly meetings.
Meet defined quality and productivity measures; evaluate processes, identify denial or payment trends, and escalate findings to management.
Reconcile account balances and apply appropriate adjustments according to established policies.
Review credit work queues and credit balances; resolve overpayments and undistributed payments and request refunds or payer retractions as needed.
Contact patients as needed to obtain additional insurance or other information required to process claims.
Generate calls or letters to obtain necessary insurance or related information before placing an account in self-pay.
Verify predefined patient demographic information and maintain documentation to verify identity.
Use the MyTime payroll system to enter hours worked, sick days, vacations, and holidays.
Use Epic, Microsoft Outlook, provider websites, SharePoint, and OneDrive as required by the role.
Promote a culture of safety, complete annual safety education requirements, maintain an organized work environment, and follow respiratory etiquette guidelines.
Assist with identifying workflow improvements and support leadership with special projects, audits, and process-improvement initiatives.
Complete required training for the billing system and assigned follow-up and denial work queues; participate in continued learning and adopt new technology and procedures.
Perform other duties assigned by management in accordance with department needs.