PFS Representative Insurance Verifier

WhidbeyHealth • Coupeville, WA

14h

About The Position

The Patient Financial Services (PFS) Representative supports WhidbeyHealth’s mission by performing duties that contribute to the organization’s financial health and well-being. Depending on assigned responsibilities, the representative may coordinate patient referrals and follow-up, verify insurance and provide financial counseling for self-pay accounts, or bill and collect insurance and self-pay accounts. The role requires professional, respectful, and patient interactions with patients, families, staff, and professional affiliates. Work must comply with federal, state, and payer-specific regulations and policies for documentation and billing.

In the Insurance Verifier function, the representative contacts insurance companies regarding preadmissions and admissions to verify patient eligibility and benefits. The representative identifies patients without appropriate referrals or authorizations, documents insurance-related information, obtains required Medicare and Tricare signatures, and keeps current with payer authorization requirements. The role also includes reviewing schedules, contacting patients to obtain demographic and insurance information, and serving as an insurance resource for other departments, including providing training on eligibility resources. The representative may provide backup to Patient Registration or Financial Advocacy as needed.

PFS Representatives may progress from Representative I to II after 12 consecutive months in the assigned department, and from Representative I–II to III after three consecutive years, provided they demonstrate the required competencies and essential functions and have no recent performance-improvement documentation on file.

Requirements

• High school diploma or equivalent.
• One year of previous related experience in a medical front office.

Nice To Haves

• Advanced education.
• Previous billing and collections experience in a medical office or hospital setting.
• Certified Revenue Cycle Specialist (CRCS) certification.
• Certified Healthcare Access Associate (CHAA) certification is acceptable for representatives working in Patient Referrals, Insurance Verifier, or Financial Advocate roles.

Responsibilities

• Contact insurance companies for preadmissions and admissions to verify patient eligibility and benefits.
• Notify the Financial Advocate and/or service department or clinic when patients lack appropriate referrals or authorizations.
• Document the contact person, eligibility, benefits, referrals, authorizations, and other pertinent information.
• Obtain patient signatures on Medicare and Tricare messages.
• Keep current on payer authorization requirements and changes.
• Act as an insurance resource for other departments and provide training on eligibility resources.
• Review department schedules and identify patients who have not yet been pre-admitted for pending services.
• Contact and interview patients by phone who have not received services within the past 90 days to obtain demographic and insurance information.
• Provide backup to the Patient Registrar or Financial Advocate as needed to support department functions.

Benefits

• Medical coverage, including HDHP with HSA and PPO options.
• Prescription drug coverage.
• Dental options, including PPO and managed-care plans.
• Vision benefits through VSP.
• Employer-paid life and AD&D insurance.
• Employer-paid long-term disability coverage.
• Health Savings Account (HSA) for employees enrolled in an HDHP.
• Healthcare and dependent Flexible Spending Accounts (FSA).
• Free, confidential Employee and Provider Assistance Programs.
• Voluntary employee-paid supplemental life and AD&D insurance.
• Voluntary employee-paid supplemental long-term disability coverage.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED