Patient Financial Services Representative - Full-time / Part-time

Essential Functions: (Detailed tasks, duties and responsibilities)

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Reviews incoming mail daily for any denials, requests for records, etc. and processes appropriately.

• Resolves claim edits and works claim queues in Revenue Manager in a timely manner.

• Works to resolve issues in work queues in Revenue Cycle in a timely manner.

• Collaborates with Patient Financial Services Clerk as well as General Accounting in reviewing Remittance Advices for accuracy of posting.

• Performs Credit Balance analysis and processes refund requests as needed

• Completes insurance follow up on accounts when needed.

• Communicates with ancillary departments when assistance is needed to resolve charge or documentation issues in order to submit claims.

• Generates and sends letters or supporting documentation to payers as needed to validate timely filing.

• Researches and logs service requests to EHR vendor to resolve system issues.

• Answers patient questions and assists with accepting payments or setting up payment arrangements in a friendly manner, providing excellent customer service. May also assist patients with the financial assistance application and process.

• Enters appropriate comments on patient accounts in EHR.

• Attends continued education webinars and meetings.

• Attends other meetings as required or requested.

Rural Health Clinic Patient Financial Services Representative

• Reviews incoming mail daily for any denials.

• Performs Credit Balance analysis and processes refund requests as needs.

• Completes insurance follow up on accounts when needed.

• Generates and sends patient statements monthly.

• Provides month end and year end reports to CFO in a timely manner.

• Posts payments to accounts in a timely and accurate manner.

• Assists patients with payment arrangements when needed.

• Identifies and submits accounts that need to be turned to bad debt.

• Performs troubleshooting and communicates with RHC EHR vendor.

• Completes insurance credentialing for all providers.

• Runs reports out of RHC EHR on demand as requested.

• Attends continued education webinars and meetings.

• Attends other meetings as required or requested.

Home Health/Hospice Patient Financial Services Representative

• Submits/bills all third party payer services rendered

• Follows up on all claims and self-pay portions

• Reviews and process credit balances

• Reviews EOB and insurance remittance for accuracy of posting; works all billing vendor edits and rejected claims through third party electronic claims processor

• Completes coding with RN's, compares coding on 485s and OASIS

• Applies for Medicaid PA's and keeps track of renewals; works with clinical staff to determine what type of PA's are needed.

• Send in prior authorization requests for Hospice nursing home patients who have Medicaid for room and board.

• Enter NOE's for all Hospice patients with Medicare and/or Medicaid within a 5 day time frame.

• Review all OASIS assessments for accuracy and submit data within allotted time frame

• Check common working file to see if patients are eligible for Home Health or Hospice services

• Submits claims to Medicaid for Nursing Home Hospice patients and check requests for payments to the nursing homes

• Downloads Remittance Advices and transfer them to the file for Accounts Receivable; respond to insurance requests for documentation; track ADR's through Ability Ease and follow-up with requested documentation as needed.

• Set up new payers in the Brightree system.

Minimum Requirements: (Educational and job experience requirements. Knowledge, skills, abilities)

Education: High School Diploma or equivalent required.

Experience: Working knowledge of computer systems, personal computer experience, and ability to operate a 10 key calculator.

Working knowledge of CPT and ICD 9 & 10 coding.

One year of billing experience preferred.