Patient Financial Svc Representative - Access Services - Full-time

Frederick Health•Frederick, MD

44d•Onsite

About The Position

Supports and is responsible for incorporating into job performance, the Frederick Health (FH) mission, vision, core values and customer service philosophy and adheres to the FH Compliance Program, including following all regulatory requirements and the FH Standards of Behavior. The Patient Financial Service Rep ensures patient charges and payments are correct, insurance authorization has been obtained and timely submission of the account to achieve payment from third party payer or the patient. Demonstrates a high level of accuracy considering the volume and filing requirements of the various insurance payers. Also recognizes the priorities of the work to be completed in order to maximize efficiency.

Requirements

Strong analytics, communication and organization skills
40 wpm typing speed
High School diploma or GED

Nice To Haves

One year of experience working in a hospital or physician collections/centralized billing function

Responsibilities

Examines denied and underpaid claims to determine reasons for discrepancies
Communicates directly with payers to follow up on outstanding claims, resolve payment variances, and achieve timely reimbursement
Provides payers with specific reasons for suspected underpayments and analyzes denial reasons given by payers
Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing A/R
Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, in order to identify and report billing compliance issues and payer discrepancies
Updates and maintains accurate files on each payer, including contact names, addresses, phone numbers, and other pertinent information; thoroughly documents all interactions with payers
Effectively handles all communications, including telephone and email, from payers and departments within the business office
Utilizes payer scorecards, identifies high-risk accounts, and prioritizes follow-up efforts
Participates in continuous quality improvement efforts on an ongoing basis, establishing goals with supervisors and tracking progress
Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management
Understands and maintains compliance with HIPAA guidelines when handling patient information
Receives and processes all types of patient payments by properly documenting and entering transactions into the system; posts payment promptly
Prepares individual bank deposits accurately and in a timely manner; checks with the bank for any direct deposits
Prepares, posts, and processes payment batches; posts denials, contractual adjustments, and guarantor payments within payment batches; and ensures all payment batches are balanced
Reconciles cash receipts and patient accounts
Investigates the source of unidentified payments to ensure they are applied to appropriate accounts
Identifies and examines underpayments to determine if additional payment can be pursued; follows up with payers and patients accordingly
Identifies and examines unapplied credits and other overpayments to determine if a refund is necessary; issues refunds promptly as appropriate
Records appropriate, up-to-date notes in patient accounts, and provides insurance collectors accounts for follow-up
Makes copies of all necessary EOBs for insurance carriers
Analyzes EOB information, including co-pays, deductibles, co-insurance, contractual adjustments, denials, and more to verify accuracy of patient balances
Reconciles shortages on both paper and electronic EOBs to determine proper allowance and correct write-off
Transfers balances to self-pay or secondary insurance
Handles telephone questions and concerns from customers; ensures complaints and inquiries are recorded and reported to management
Utilizes the safe to deposit large bills and sums of money from the cash drawer; keeps minimum allowable amount in drawer at all times
Balances cash register/box daily or as instructed
Demonstrates exceptional guest relations by promptly answering phone calls and answering patient questions
Complies with all organizational policies regarding ethical business practices
Performs other duties as assigned