Patient Financial Services Representative 4 (Bilingual)

Inova•VA, VA

7d•$23 - $37

About The Position

The Patient Financial Services Representative 4 performs the duties of a Patient Financial Services Representative 3 and is responsible for the timely and accurate editing, submission, and follow-up of assigned claims across multiple payer types, including commercial, managed care, Blue Cross, Medicare, and Medicaid. The representative ensures claims meet clearinghouse and payer processing criteria and follows up on assigned work lists in accordance with departmental productivity and quality standards. They inform management of claims-process issues and potential resolutions, support and guide team members, and perform assigned duties in the absence of a supervisor or manager.

Requirements

Three years of experience in revenue cycle, finance, customer service, or data analytics.
Associate degree, or an additional three years of experience appropriate to the position.
Bilingual; specified as part of the job title.
Certification is not required.
Licensure is not required.

Responsibilities

Submit clean claims on the day they are received using the appropriate medium and including all required attachments.
Serve in place of the supervisor or manager when they are absent.
Resolve complex issues individually or by coordinating information and actions across team members, Patient Accounts staff, hospital departments, or payers; seek supervisor assistance when needed.
Review claims and identify or make corrections, or initiate resolutions, within 24 hours of receipt.
Identify when team members need support and provide guidance to promote efficiency and productivity.
Handle complex and/or highest-dollar accounts and provide follow-up according to established protocol or SRGs.
Document account activity promptly and handle correspondence within 48 hours of receipt.
Record activity in HealthQuest and TRAC, ensuring documentation is professional, appropriate, accurate, and compliant with departmental quality review standards.
Work payer response and rejection reports in accordance with departmental productivity and quality review standards.
Maintain knowledge of payer requirements, UB-92 standards, hospital, clearinghouse, and payer system functionality, and hospital policies and procedures.
Follow management direction to resolve issues and provide support, education, and guidance to team members.
Perform additional duties as assigned.