Senior Lead Data Engineer

Catholic Health LI - New York, NY

Full-time

New York, NY

Hospitals

About the position

The Hospital Patient Financial Services (PFS) Representative plays a crucial role in managing patient accounts and ensuring timely billing and payment from third-party payers. This position involves reviewing accounts, addressing complex claim issues, and collaborating with various stakeholders to enhance operational effectiveness and patient satisfaction.

Responsibilities

• Review hospital accounts assigned by system-generated work-queues or reports to determine appropriate actions for moving accounts forward in the revenue cycle.
• Initiate phone calls, submit website inquiries, write letters of appeal to payers, and inquiries to patients.
• Recommend write-offs and adjustments, ensuring account balances are valued as per payers' contracts.
• Meet and/or exceed productivity and quality standards as set forth in the department's policies and procedures.
• Perform root cause analyses on accounts with a solutions focus; track trends and escalate carrier or revenue cycle system issues to the Team Lead and/or Supervisor.
• Participate in projects and audits as directed by leadership; collect and assemble financial documents related to billing and payment to substantiate services and reimbursement.
• Collaborate with internal departments, external vendors, and IT for issue resolution and operational effectiveness.
• Regularly meet with Team Lead/Supervisor to discuss and resolve billing obstacles, reimbursement issues, and process improvements.
• Monitor accounts for timely filing guidelines and prioritize work accordingly.
• Ensure claims are compliant, meet payer requirements, and resolve billing errors/claim rejections timely to minimize financial losses.
• Escalate and report any delays in claims adjudication.
• Assess payments (or lack of) and adjustments for accuracy and timeliness.
• Understand and review payer reimbursement systems/contracts to establish accuracy in the A/R.
• Review regulatory and contract updates to understand impacts to reimbursement from federal, state, and managed care payers.
• Correct transactions and transfer balances to responsible parties as necessary, reporting and documenting ongoing issues to management.
• Promote and deliver a positive patient experience and patient satisfaction.
• Perform other duties as assigned.
• Adhere to all organizational policies and procedures.

Requirements

• High School diploma or equivalent required.
• Industry certification (AHIMA, HFMA, AAPC, etc.) is preferred.
• Competent in a variety of patient accounting systems and associated applications.
• Strong knowledge of third-party operations and reimbursement structures.
• Knowledgeable in medical terminology, CPT, HCPCS, and ICD10 coding used in healthcare.
• Ability to work independently, exercising good judgment, and multi-task in a high-stress, fast-paced, and ever-changing service environment with patients, patient's family, insurance carriers, and leadership.
• Detail-oriented with solid analytical problem-solving skills.