PFS Representative Patient Referrals

WhidbeyHealth•Oak Harbor, WA

About The Position

The Patient Financial Services (PFS) Representative supports WhidbeyHealth’s mission to provide quality healthcare by performing duties that support the organization’s financial health. Depending on assigned functions, the representative may coordinate patient referrals and follow-up care, verify insurance and provide financial counseling, or bill and collect insurance and self-pay accounts. The position requires professional conduct and considerate, respectful, patient service toward patients, families, staff, and professional affiliates. The representative follows applicable federal, state, and payer regulations and policies for documentation and billing. In the Patient Referrals function, the representative coordinates referrals and follow-up care with specialists, facilities, agencies, and insurance companies; obtains and shares relevant medical records and test information; documents referral activity; monitors progress; and keeps staff informed about relevant changes to procedures, laws, and insurance requirements. The representative works with providers and designated staff to coordinate patient needs, completes and maintains referral forms and records, scans documentation into the electronic medical record, and submits prior authorization requests for referred services when required. The representative may provide backup to Patient Registrar or HIM Technician functions. Other possible functions include insurance verification, financial advocacy, and billing and collections. These duties include verifying eligibility and benefits, documenting insurance contacts and authorization information, counseling patients about balances and payment options, helping patients identify alternative financial resources, billing accounts, following up on claims and outstanding balances, processing payments and refunds, preparing appeals, and resolving account questions. The representative may provide backup to Patient Registrar, Financial Advocate, or Insurance Verifier functions, depending on assignment. A PFS Representative I may advance to Representative II after 12 consecutive months in the assigned department if they demonstrate the ability to perform the position’s essential functions and competencies and have no recent performance-improvement documentation on file. Advancement to Representative III may be possible after three consecutive years as a Representative I or II under the same performance conditions.

Requirements

High school diploma or equivalent.
One year of previous related experience in a medical front office.
Professional behavior and the ability to show consideration, respect, and patience toward patients, families, staff, and professional affiliates.
Ability to follow applicable federal, state, and payer-specific regulations and policies related to documentation and billing.

Nice To Haves

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

Responsibilities

Coordinate patient referrals and follow-up care with specialists, facilities, agencies, and insurance companies.
Document referral information clearly, obtain and distribute relevant chart notes, laboratory results, radiology images, and patient history, and monitor referral progress.
Coordinate patient needs and progress with providers and designated staff to support a cohesive referral experience.
Complete referral forms according to department and governmental guidelines, scan documentation into the electronic medical record, and maintain and update referral forms and filing systems.
Keep department staff informed of changes to referral procedures, laws, and insurance requirements that may affect patient care.
Stay current on payer authorization requirements and submit prior authorization requests for referred internal or external examinations and procedures originating within the clinic department.
Provide backup for Patient Registrar or HIM Technician duties as needed.
Contact insurers regarding preadmissions and admissions to verify patient eligibility and benefits.
Notify the Financial Advocate, service department, or clinic when patients lack appropriate referrals or authorizations; document insurance contacts and pertinent eligibility, benefit, referral, and authorization information.
Obtain required Medicare and Tricare message signatures and help other departments use eligibility resources, including providing training.
Review department schedules for patients who have not been pre-admitted and contact applicable patients to obtain demographic and insurance information.
Interview patients and provide financial counseling regarding patient balances; arrange valid financial resolutions and assist patients in finding alternative financial resources.
Identify patients for COBRA and follow through for approval; obtain necessary release signatures and complete indicator reports on time.
Provide requested price quotes and explain the financial assistance policy to patients or guarantors.
Bill insurance and self-pay accounts electronically and manually in a timely manner.
Follow up on insurer requests for information and payment, and contact patients or guarantors for information or account resolution.
Accept payments by phone, process refunds, and promptly post payments to accounts.
Work with third-party payers, collection agencies, and attorneys as needed; process technical denials and prepare and follow up on insurance appeals.
Work daily queues and reports within department productivity targets; review accounts and remittances for correct payment and obtain supporting documents for rebilling, refunds, and audits.
Enter statistical figures in online reports and maintain the Itemized Statement Request Line.
Review First Choice and Pacific Medicaid invoices for proper billing, identify errors, and resolve them before payment requests are sent.
Complete financial rounding with inpatient and observation patients to review financial responsibility after insurance coverage or for self-pay.
Provide prompt, courteous service to visitors and callers, resolve inquiries when possible, and transfer them to the appropriate party when needed.