PFS Billing Representative | Full Time | Day

Concord Hospital Health System•Concord, NH

8d•Hybrid

About The Position

The Patient Financial Services (PFS) Billing Representative is responsible for accurate and timely billing and/or follow up of hospital and/or professional claims to third-party payers and patients. This role ensures compliance with federal, state, and payer-specific regulations while maximizing reimbursement and maintaining excellent customer service standards.

Requirements

High school diploma or GED required
Strong computer skills (Microsoft Office, billing software).
Excellent analytical, organizational, and problem-solving skills.
Strong written and verbal communication skills.

Nice To Haves

1—3 years of medical billing or healthcare revenue cycle experience
Experience with hospital-based billing (inpatient, outpatient, or emergency services).
Knowledge of UB-04 and CMS-1500 claim forms.
Knowledge of CPT, ICD-IO-CM, and HCPCS coding principles (basic understanding).
Experience with hospital billing systems and electronic health records (EHR).

Responsibilities

Prepare, review, and submit electronic and paper claims to insurance carriers and government payers depending on assigned team.
Ensure claims are compliant with CMS, Medicare, Medicaid, and commercial payer guidelines as appropriate for team.
Monitor claim status and resolve claim edits, rejections, and denials in a timely manner.
Submit corrected claims and appeals as needed.
Follow up on unpaid, underpaid, or denied claims as assigned.
Research and resolve billing discrepancies.
Prepare and submit appeals with appropriate documentation.
Document all actions and activities taken in the billing system.
Maintain productivity and quality benchmarks.
Timely and accurate management of all assigned work Queues.
Respond to insurance inquiries regarding claim processing/issues.
Provide clear, professional communication to all customers while maintaining patient confidentiality.
Provide accurate, timely feedback to Patient Account Resolution staff regarding patient inquiries.
Adhere to HIPAA regulations and hospital policies.
Maintain confidentiality of protected health information (PHI).
Stay current on payer updates, state and federal billing regulations, and reimbursement procedures.
Collaborate with team members on a daily basis by sharing information and assistance as needed.
Assists with team members' responsibilities in their absence.
Works cooperatively to resolve billing issues with other teams including but not limited to: Provider Offices, Patient Account Resolution, Hospital Departments and Registration.
Maintain up to date knowledge of systems used by PFS to include but not limited to: Cerner, payer websites, Availity, MMIS, Connex, FISS, FinThrive, Policy Tech and Microsoft Office Products as applicable.