Patient Financial Services Representative

Hospital Revenue Cycle Operations

• Process inpatient and outpatient hospital billing, including claim submission and follow-up
• Perform payment posting, adjustments, and account reconciliation
• Monitor assigned hospital accounts receivable and follow up on unpaid or underpaid claims
• Investigate and resolve claim denials, coding issues, and billing discrepancies
• Ensure timely account resolution in accordance with hospital billing guidelines

Medicaid & Insurance Support

• Verify insurance coverage and Medicaid eligibility for hospital patients
• Aid with Medicaid enrollment, applications, and redeterminations for admitted and outpatient patients
• Submit and track Medicaid and third-party claims, including corrections and appeals
• Identify denial trends and escalate issues impacting reimbursement

Patient Financial Counseling

• Explain hospital billing processes, insurance coverage, and patient financial responsibility
• Aid patients in applying for charity care, financial assistance, and presumptive eligibility programs
• Collect required documentation and ensure completeness of applications
• Set up payment plans in accordance with hospital policies

Customer Service

• Respond to patient and guarantor inquiries regarding hospital bills and insurance claims
• Provide clear, compassionate communication, especially in high-stress hospital situations
• Resolve routine issues and escalate complex cases to supervisors

Compliance & Documentation

• Maintain compliance with hospital policies, HIPAA, and federal/state regulations
• Ensure accurate and complete documentation in hospital billing systems
• Support audit activities by maintaining proper records and following internal controls

Collaboration

• Coordinate with patient access, registration, case management, utilization review, and clinical departments
• Communicate with insurance companies and Medicaid representatives to resolve account issues
• Support discharge planning by addressing financial clearance and eligibility needs

Qualifications

• High school diploma or equivalent required
• Associate’s or bachelor’s degree in healthcare administration, Business, or related field preferred
• 1–3 years of experience in hospital patient financial services, billing, or revenue cycle operations
• Familiarity with Medicaid eligibility and hospital-based financial assistance programs

Skills

• Knowledge of hospital billing systems and electronic health records (EHR)
• Strong understanding of insurance processes, including Medicaid and Medicare
• Excellent customer service and communication skills in a healthcare environment
• Ability to manage multiple accounts and meet productivity standards
• Attention to detail, accuracy, and problem-solving abilities
• Ability to work in a fast-paced hospital setting

Benefits

• Paid Sick Time - effective 90 days after employment
• Paid Vacation Time - effective 90 days after employment
• Health, vision & dental benefits - eligible at 30 days, following the 1st of the following month
• Short and long-term disability and basic life insurance - after 30 days of employment