PFS Representative Patient Referrals

WhidbeyHealth•Oak Harbor, WA

About The Position

The Patient Financial Services Representative supports the mission of providing quality healthcare to WhidbeyHealth by performing duties that contribute to the organization’s financial health and well-being. Depending on assigned responsibilities, the representative coordinates patient referrals and follow-up care, verifies insurance eligibility and benefits, provides financial counseling, and bills and collects insurance and self-pay accounts. The role requires professional conduct and consideration, respect, and patience toward patients, families, staff, and professional affiliates. The representative follows applicable federal, state, and payer-specific regulations and policies for documentation and billing. The role may encompass patient referrals, insurance verification, financial advocacy, and billing and collections. Referral duties include arranging specialist and facility appointments, coordinating follow-up, maintaining referral documentation, obtaining and sharing relevant medical records, monitoring referral progress, and submitting prior authorization requests. Insurance verification duties include checking eligibility and benefits, documenting findings, identifying missing referrals or authorizations, and serving as an insurance resource to other departments. Financial advocacy duties include counseling patients about balances, arranging financial resolutions, and helping patients identify alternative resources. Billing and collection duties include submitting bills, following up with insurers and patients, processing payments and refunds, resolving account issues, preparing appeals, and providing courteous service to callers and visitors. Representatives may provide backup for Patient Registrar, HIM Technician, or Financial Advocate functions as needed. Advancement from Representative I to II may be considered after 12 consecutive months in the assigned department with demonstrated ability to perform essential functions and competencies and no recent performance improvement documentation. Advancement from Representative II to III may be considered after three consecutive years as a Representative I–II in the assigned department under the same performance conditions.

Requirements

High school diploma or equivalent required.
One year of previous related experience in a medical front office.
Follow applicable federal, state, and payer-specific regulations and policies for documentation and billing practices.
Demonstrate professional behavior and consideration, respect, and patience toward patients, families, staff, and professional affiliates.

Nice To Haves

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

Responsibilities

Coordinate patients through referrals and follow-up care by scheduling with specialists, facilities, agencies, and insurance companies.
Provide timely patient follow-up and document referral information clearly for staff.
Request and distribute chart notes, laboratory results, radiology images, and patient history to referral sources, and monitor progress.
Inform department staff about changes in referral procedures, laws, and insurance requirements that affect care plans.
Coordinate patient needs and progress with providers and designated staff as part of the care team.
Complete forms according to department and governmental guidelines; scan documentation into the electronic medical record; maintain and update referral forms and filing systems.
Submit prior authorizations for referred internal or external exams and procedures, and stay current on payer authorization requirements.
Verify insurance eligibility and benefits for preadmissions and admissions; notify relevant staff when referrals or authorizations are missing.
Document insurance contacts, eligibility, benefits, referrals, authorizations, and other pertinent information.
Obtain required Medicare and Tricare message signatures and serve as an insurance resource, including training others in eligibility resources.
Review schedules for patients not pre-admitted for pending services and contact patients to obtain demographic and insurance information when needed.
Interview patients about balances, provide financial counseling, arrange financial resolutions, and assist patients in seeking alternative financial resources.
Identify patients for COBRA and follow through for approval; obtain necessary release signatures and complete indicator reports on time.
Provide price quotes when requested.
Bill insurance and self-pay accounts electronically and manually in a timely manner, and follow up on requests for information and payments within department productivity standards.
Contact patients or guarantors to obtain information or collect or resolve accounts; accept phone payments and process refunds.
Post payments promptly, work with third-party payers, collection agencies, and attorneys as needed, and explain financial assistance policy.
Work through daily queues and reports within productivity targets; review accounts and remittances for correct payment; support rebilling, refunds, and audits.
Prepare insurance appeals, follow up as needed, process technical denials, maintain the Itemized Statement Request Line, and review invoices for proper billing.
Complete financial rounding with inpatient and observation patients to review responsibility after insurance or for full self-pay.
Provide prompt and courteous service to visitors and callers, resolve inquiries, or transfer them to the appropriate party.
Provide backup for Patient Registrar, HIM Technician, or Financial Advocate functions as needed.