Position Status:

Shift:

Hours per week:

Job Information
Exemption Status: Non-Exempt

A Brief Overview
Patient Financial Services Representative is responsible for ensuring efficient, accurate and timely processing patient accounts, uploading applications, service registration and final third- party payment account resolution after initial bill submission for automobile, workers compensation and liability patient accounts. These activities are completed following established policies and procedures, and in compliance with JCAHO, Medicare, Payer contracts, HIPAA, regulatory agencies and the organization's Code of Conduct.

Education Qualifications

• High School Diploma / GED Required
• Associate's Degree Preferred

Experience Qualifications

• 1 year Experience in healthcare financial services, patient registration, patient scheduling, or claims processing experience in the liability insurance field. Required

Skills and Abilities

• Excellent interpersonal and communication skills and the ability to exhibit patience.
• Detailed knowledge of major third-party billing and contract.
• Working knowledge of basic medical terminology.
• Ability to work productively as part of a team.
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or government regulations.
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages. Ability to apply concepts of basic Algebra.

What you will do

• Responsible for the processing of patient accounts after initial bill submission to final 3rd party payment resolution. This responsibility includes timely and accurate resolution of denied claims and insurance correspondence and follow-up on unpaid claims exceeding the clean claim payment cycle.
• Processes patient accounts from uploading into the clearinghouse application through final claim submission, both manual and electronic. This responsibility includes resolving remaining bill edit failures, claim submission, receipt reconciliation and rebilling when necessary.
• Collects, validates, and updates patient’s comprehensive data set and documenting in the registration system, completing electronic insurance verifications, identifying managed care issues and referring as appropriate for resolution, obtaining appropriate signatures to satisfy legal and health system requirements and completion of required forms including Medicare MSP.
• Identifies and notifies management of customer service issues and potential process/system problems that cause billing and payment errors and assists in improvement implementation as requested.
• Accurately and efficiently distributes and/or prepares various reports; processes account credit balances, refund requests, cash transfers, returned checks and unidentified payments in a timely manner.
• Accurately posts payments and adjustments and balances all entries according to payer cash processing and reconciliation procedures.
• Answers questions from other staff or clinic offices by phone or e-mail in a timely manner.
• Consistently and accurately documents accounts with activities as needed in a timely manner.
• Analyzes and resolves insurance correspondence for unpaid claims. Validates accuracy of insurance information and completed insurance verification for specific payors that do not participate in electronic eligibility by established procedures (phone calls, websites, etc.).
• Completes manual billing process for claims that cannot be sent electronically.
• Creates encounters for Physicians providing Hospital professional services including but not limited to ED professional fees, Hospital visits, Invasive procedures, Hospitalists, Radiologists, Therapies (including Chemo & Radiation), Counseling, etc.
• Generates re-bills after all edits have been resolved and re-submits claims to third-party payor. 
• Identifies and correctly resolves all electronic claim edits failures in a timely manner.
• Identifies missing or incorrect requirements of rejected claims and either resolves or forwards promptly to appropriate staff for resolution.
• Monitors and completes patient accounts on billing hold for additional information within ten business days.
• Reviews and resolves unbilled encounter report. Reviews Hospital cards/interface charges/electronic charge sheets, etc. for accuracy and resolves missing/incorrect information as necessary. Reviews Posting & Exception Reports and verifies that information has been accurately recorded on the account receivable system.

Required for All Jobs

• Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health
• Performs other duties as assigned

Patient Facing Options

• Position is Not Patient Facing

Remote Work Guidelines

• Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards.
• Stable access to electricity and a minimum of 25mb upload and internet speed.
• Dedicate full attention to the job duties and communication with others during working hours.
• Adhere to break and attendance schedules agreed upon with supervisor.
• Abide by Stormont Vail’s Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.

Remote Work Capability

• Hybrid

Scope

• No Supervisory Responsibility
• 
  
• No Budget Responsibility No Budget Responsibility

Physical Demands

• Balancing: Occasionally 1-3 Hours
• Carrying: Occasionally 1-3 Hours
• Climbing (Ladders): Rarely less than 1 hour
• Climbing (Stairs): Rarely less than 1 hour
• Crawling: Rarely less than 1 hour
• Crouching: Rarely less than 1 hour
• Driving (Automatic): Rarely less than 1 hour
• Driving (Standard): Rarely less than 1 hour
• Eye/Hand/Foot Coordination: Frequently 3-5 Hours
• Feeling: Occasionally 1-3 Hours
• Grasping (Fine Motor): Frequently 3-5 Hours
• Grasping (Gross Hand): Frequently 3-5 Hours
• Handling: Occasionally 1-3 Hours
• Hearing: Frequently 3-5 Hours
• Kneeling: Occasionally 1-3 Hours
• Lifting: Occasionally 1-3 Hours up to 30 lbs
• Operate Foot Controls: Rarely less than 1 hour
• Pulling: Occasionally 1-3 Hours up to 30 lbs
• Pushing: Occasionally 1-3 Hours up to 30 lbs
• Reaching (Forward): Occasionally 1-3 Hours up to 30 lbs
• Reaching (Overhead): Occasionally 1-3 Hours up to 30 lbs
• Repetitive Motions: Frequently 3-5 Hours
• Sitting: Frequently 3-5 Hours
• Standing: Occasionally 1-3 Hours
• Stooping: Rarely less than 1 hour
• Talking: Occasionally 1-3 Hours
• Walking: Occasionally 1-3 Hours

Working Conditions

• Burn: Rarely less than 1 hour
• Chemical: Rarely less than 1 hour
• Combative Patients: Rarely less than 1 hour
• Dusts: Rarely less than 1 hour
• Electrical: Rarely less than 1 hour
• Explosive: Rarely less than 1 hour
• Extreme Temperatures: Rarely less than 1 hour
• Infectious Diseases: Rarely less than 1 hour
• Mechanical: Rarely less than 1 hour
• Needle Stick: Rarely less than 1 hour
• Noise/Sounds: Rarely less than 1 hour
• Other Atmospheric Conditions: Rarely less than 1 hour
• Poor Ventilation, Fumes and/or Gases: Rarely less than 1 hour
• Radiant Energy: Rarely less than 1 hour
• Risk of Exposure to Blood and Body Fluids: Rarely less than 1 hour
• Risk of Exposure to Hazardous Drugs: Rarely less than 1 hour
• Hazards (other): Rarely less than 1 hour
• Vibration: Rarely less than 1 hour
• Wet and/or Humid: Rarely less than 1 hour

Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment.

Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.