Patient Financial Services Rep I

Full-time - Entry Level

Jackson, TN

Hospitals

About the position

The Patient Financial Services Representative I plays a crucial role in supporting management with the billing and collection of accounts receivable for both inpatient and outpatient accounts. This position is essential for cash application and reconciliation, as well as resolving customer service issues. A fundamental understanding of the Revenue Cycle is necessary, as the representative must evaluate and secure all appropriate financial resources for patients to maximize reimbursement to the health system. The PFS Representative, Level 1 is expected to possess basic knowledge of accounting, healthcare, and general office procedures, and must be capable of clear and concise communication, both verbally and in writing, with various stakeholders including peers, supervisors, payers, physicians, and patients. In this role, the representative is responsible for account resolution, managing correspondence with payers, patients, and departments, and continuously working to improve the aging of receivables while minimizing controllable losses. Responsibilities also include notifying patients or guarantors of their liabilities, verifying insurance benefits, and assisting customers with billing inquiries. A strong focus on customer service and process improvements is critical, along with effective communication and conflict resolution skills. The PFS Representative, Level 1 must complete all initial and annual training relevant to the role and comply with all applicable laws, regulations, and policies. The essential job functions include reviewing institutional and professional claims for appropriate use of procedure, modifiers, and diagnostic codes to ensure maximum reimbursement. The representative will utilize electronic billing systems and in-house computer systems to edit, modify, or change information on claim forms for various payers. They will also resolve system edits and claim errors promptly, monitor governmental regulatory mandates for each claim, and ensure compliance with hospital, federal, and payer guidelines. The role requires identifying problem accounts, performing follow-ups, and assisting in the timely resolution of claims to improve the aging of receivables. Additionally, the representative will analyze and process correspondence related to claims, manage overpayments, and prepare credit balance reports as needed.

Responsibilities

• Support management in billing and collection of accounts receivable for inpatient and outpatient accounts.
• Perform cash application and reconciliation, resolving customer service issues as needed.
• Review institutional and professional claims for appropriate use of procedure, modifiers, and diagnostic codes.
• Utilize electronic billing systems to edit, modify, or change information on claim forms for various payers.
• Resolve system edits and claim errors in a timely manner.
• Monitor governmental regulatory mandates for each claim to meet medical necessity guidelines.
• Adjust pre-bill denials before submitting claims according to defined procedures.
• Maintain, monitor, and perform follow-up on patient accounts until benefits have been paid or resolved.
• Identify problem accounts and work towards timely resolution.
• Assist in improving the aging of receivables while minimizing controllable loss categories.
• Identify and perform follow-up necessary to bill primary claims to appropriate insurance companies.
• Work with clinical and other support departments to correct charges and claims for prompt payment.
• Edit, modify, and complete UB-04 and CMS-1500 forms for secondary/tertiary payer claims.
• Perform post review of all payments applied to assigned accounts to ensure compliance with regulations and guidelines.
• Identify account overpayments and initiate refund requests as necessary.
• Prepare periodic credit balance reports for the assigned ledger.
• Investigate and respond to questions or requests for additional information from patients and authorized parties.
• Utilize systems and tools to achieve production and quality targets for resolution of patient accounts.
• Demonstrate proficiency in billing processes, account follow-up, denials management, and payment posting.
• Ensure data integrity for the generation of patient statements and correspondence.
• Initiate, reconcile, and maintain collection agency assignment of accounts meeting bad debt status.
• Provide oversight to other representatives to ensure quality and efficiency of functions performed.

Requirements

• High School Diploma required.
• 1-2 years of healthcare or related experience preferred.
• Basic knowledge of accounting principles and general office procedures, including healthcare revenue cycle operations.
• Ability to understand principles impacting accounts receivable, including debit and credit transactions, charge transfers, and contractual allowances.
• Basic knowledge of standard PC word processing and website navigation for payer follow-up.
• Demonstrated communication skills to clearly and concisely communicate with peers, managers, payers, physicians, and patients.
• Strong interpersonal skills and the ability to diplomatically work through various issues.
• Ability to read, write, interpret, and apply oral and written procedures and perform mathematical calculations.
• Basic analytical and mathematical skills required.
• Maturity and responsibility for an assigned section within the Accounts Receivable work group.

Nice-to-haves

• Knowledge and general understanding of medical coding systems preferred.