PFS Representative CBO Billing Follow-up Denials Mgt

Banner Health•Phoenix, NV

21h•Remote

About The Position

Banner Health is seeking a PFS Representative for their Central Billing Office (CBO) team, focusing on Billing Follow-up and Denials Management. This role is crucial for reducing Accounts Receivable (AR) and improving the patient experience post-care. The representative will work with insurance companies on behalf of patients to secure payments for acute and/or ambulatory teams. Key responsibilities include researching and holding payers accountable for contracted rates within specified timeframes, utilizing knowledge of Explanation of Benefits (EOBs) and medical claims. Experience with various payers and understanding of common denials like no authorization or eligibility issues is beneficial. This is a full-time, remote position with typical hours of Monday-Friday, 8am-5pm, and Banner provides equipment. The ideal candidate will have at least one year of patient financial services (Central Billing) or medical claims experience, with demonstrated experience in submitting appeals and understanding EOBs. General knowledge of codes used for claim processing is also expected. The position is remote and only open to residents in specific states: AL, AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, LA, MD, MI, MN, MO, MS, NC, ND, NE, NH, NY, NM, NV, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI, WV, WY.

Requirements

High school diploma/GED or equivalent working knowledge.
Requires knowledge of patient financial services, financial, collecting services or insurance industry experience processes normally acquired over one or more years of work experience.
Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently.
Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences.
Strong knowledge in the use of common office software, word processing, spreadsheet, and database software are required.
1 year patient financial services (Central Billing) or medical claims experience (clearly reflected in attached resume).
Experience with submitting appeals and understanding of EOB.
General knowledge of codes used for claim processing.

Nice To Haves

Experience with different payers is a plus.
Knowledge for various denials, such as no authorization, eligibility denials, etc.
Work experience with the Company’s systems and processes is preferred.
Previous cash collections experience is preferred.
Additional related education and/or experience preferred.

Responsibilities

May be assigned to process payments, adjustments, claims, correspondence, refunds, denials, financial/charity applications, and/or payment plans in an accurate and timely manner, meeting goals in work quality and productivity.
Coordinates with other staff members and physician office staff as necessary ensure correct processing.
As assigned, reconciles, balances and pursues account balances and payments, and/or denials, working with payor remits, facility contracts, payor customer service, provider representatives, spreadsheets and the company’s collection/self-pay policies to ensure maximum reimbursement.
May be assigned to research payments, denials and/or accounts to determine short/over payments, contract discrepancies, incorrect financial classes, internal/external errors.
Makes appeals and corrections as necessary.
Builds strong working relationships with assigned business units, hospital departments or provider offices.
Identifies trends in payment issues and communicates with internal and external customers as appropriate to educate and correct problems.
Provides assistance and excellent customer service to these internal clients.
Responds to incoming calls and makes outbound calls as required to resolve billing, payment and accounting issues.
Provides assistance and excellent customer service to patients, patient families, providers, and other internal and external customers.
Works as a member of the patient financial services team to achieve goals in days and dollars of outstanding accounts.
Reduces Accounts Receivable balances.
Uses systems to document and to provide statistical data, prepare issues list(s) and to communicate with payors accurately.
Works independently under general supervision, following defined standards and procedures.
Reports to a Supervisor or Manger.
Uses critical thinking skills to solve problems and reconcile accounts in a timely manner.