Patient Financial Services Associate II

Position Overview

The Patient Financial Services Associate II (PFSAII) position at Exact Sciences is responsible for the accurate and timely processing of claims, appeals, denials, and statements for Exact Sciences. This position requires a PFSAII to demonstrate medical insurance knowledge by resolving billing discrepancies, eligibility, denials, appeals, and aged unpaid claim follow up for commercial, government, and plan coverage for optimal Account Receivable (AR) outcomes.

• Demonstrate medical insurance knowledge by resolving billing discrepancies, eligibility, denials, appeals, and aged unpaid claim follow up for commercial, government, and plan coverage for optimal Account Receivable (AR) outcomes.
• Communicate insurance information to ancillary departments and ensure appropriate coverage by utilizing Epic, external portals, and other software.
• Review and resolve payor denials, appeals, and claims with no response from the payors via portals, calls to payors, and system investigations to ensure accurate claim resolution.
• Read and understand explanations of payments to resolve back end claim resolution.
• Independently determine initial or ongoing patient insurance eligibility verification, investigate, and correct accounts within Epic; including updates to patient demographics, financial information, and guarantor information.
• Ability to interact with various insurances and third-party payors accurately and timely to ensure authorization is obtained and documented based on internal and external policies and regulations.
• Research missing or erroneous information on accounts using various portals and other resources; including outreach and identification of unknown payors.
• Review/edit claims and appeals prior to submitting to clearinghouse.
• Analyze, research, and resolve claim issues applying federal, state, and payor rules and procedures with a high degree of independence.
• Correct rejected claims from the claim's scrubber, clearinghouse, or payor.
• Review explanations of payments, analyze, and complete appropriate steps for all denials by appropriately identifying claim resolution next steps; including appealing, writing off, or sending statements.
• Investigate payor underpayments.
• Follow up with payors via phone on unpaid aging claims.
• Reviews denials and determines appropriate next actions; such as sending appeals or patient statements.
• Provide any supporting documentation needed by insurance payor.
• Perform accurate and timely write-offs following identification of uncollectible accounts adhering to policies and guidelines.
• Contribute ideas for workflows and best practices to maximize opportunities for performance, process, and net revenue collections improvement.
• Provide ad-hoc support, as necessary, within the department (i.e., special projects, provide support due to outages/high volume).
• Complete position responsibilities within the appropriate time frame while adhering to quality standards.
• Stay current with relevant medical billing regulations, rules, and guidelines.
• Maintain strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Excellent problem-solving abilities and organizational skills.
• Ability to communicate effectively with all levels of staff through both verbal and written communications.
• Ability to work in a team environment.
• Ability to adapt to changing workload and circumstances effectively; able to respond to new information quickly.
• Diligent about arriving to work on time and completing tasks that are assigned in a timely manner.
• Conducts self in a professional manner in all interactions with members of the Exact Sciences Clinical Laboratory team, clients, and associates.
• Possess a positive attitude.
• Work with others in a spirit of teamwork and cooperation.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
• Support and comply with the company’s Quality Management System policies and procedures.
• Regular and reliable attendance.
• Able to work normal schedule of Monday through Friday during normal business hours.
• Able to work in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
• Able to work on a computer and phone simultaneously.
• Able to use a telephone through a headset.

Essential Duties

• Independently determine initial or ongoing patient insurance eligibility verification, investigate, and correct accounts within Epic; including updates to patient demographics, financial information, and guarantor information.
• Ability to interact with various insurances and third-party payors accurately and timely to ensure authorization is obtained and documented based on internal and external policies and regulations.
• Research missing or erroneous information on accounts using various portals and other resources; including outreach and identification of unknown payors.
• Review/edit claims and appeals prior to submitting to clearinghouse.
• Analyze, research, and resolve claim issues applying federal, state, and payor rules and procedures with a high degree of independence.
• Correct rejected claims from the claim’s scrubber, clearinghouse, or payor.
• Review explanations of payments, analyze, and complete appropriate steps for all denials by appropriately identifying claim resolution next steps; including appealing, writing off, or sending statements.
• Investigate payor underpayments.
• Follow up with payors via phone on unpaid aging claims.
• Reviews denials and determines appropriate next actions; such as sending appeals or patient statements.
• Provide any supporting documentation needed by insurance payor.
• Perform accurate and timely write-offs following identification of uncollectible accounts adhering to policies and guidelines.
• Contribute ideas for workflows and best practices to maximize opportunities for performance, process, and net revenue collections improvement.
• Provide ad-hoc support, as necessary, within the department (i.e., special projects, provide support due to outages/high volume).
• Complete position responsibilities within the appropriate time frame while adhering to quality standards.
• Stay current with relevant medical billing regulations, rules, and guidelines.
• Maintain strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Excellent problem-solving abilities and organizational skills.
• Ability to communicate effectively with all levels of staff through both verbal and written communications.
• Ability to work in a team environment.
• Ability to adapt to changing workload and circumstances effectively; able to respond to new information quickly.
• Diligent about arriving to work on time and completing tasks that are assigned in a timely manner.
• Conducts self in a professional manner in all interactions with members of the Exact Sciences Clinical Laboratory team, clients, and associates.
• Possess a positive attitude.
• Work with others in a spirit of teamwork and cooperation.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
• Support and comply with the company’s Quality Management System policies and procedures.
• Regular and reliable attendance.
• Able to work normal schedule of Monday through Friday during normal business hours.
• Able to work in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
• Able to work on a computer and phone simultaneously.
• Able to use a telephone through a headset.

Minimum Qualifications

• High School Diploma or General Education Degree (GED).
• 2 years of experience in medical billing, claims, and/or insurance processing.
• Extensive and current working knowledge of government, managed care, and commercial insurances claim submission requirements, reimbursement guidelines, and denial reason codes.
• Knowledge of medical terminology and/or health insurance terms.
• Knowledge of EHR operating systems and work involving electronic records.
• Proficient in computer systems and keyboarding skills.
• Demonstrated strong attention to detail and focus on quality output.
• Demonstrated ability to perform the Essential Duties of the position with or without accommodation.
• Authorization to work in the United States without sponsorship.

Preferred Qualifications

• Related Associate degree or medical billing certification.
• 4+ years of experience in medical or insurance billing field.
• Experience with Epic or other EHR application.