Patient Financial Services Representative - Patient Financial Services SVHC - FT - Day

Position Status: Full time

Shift: First Shift (Days - Less than 12 hours per shift) (United States of America)

Hours Per Week: 40

Exemption Status: Non-Exempt

About the role

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.

Responsibilities

• Process patient accounts after initial bill submission to final third‑party payment resolution, including timely and accurate resolution of denied claims and insurance correspondence and follow‑up on unpaid claims exceeding the clean claim payment cycle.
• Process patient accounts from uploading into the clearinghouse application through final claim submission, both manual and electronic; resolve remaining bill edit failures, claim submission, receipt reconciliation and rebilling when necessary.
• Collect, validate, and update patient’s comprehensive data set and document in the registration system; complete electronic insurance verifications, identify managed care issues and refer as appropriate; obtain appropriate signatures to satisfy legal and health system requirements and complete required forms including Medicare MSP.
• Identify and notify management of customer service issues and potential process/system problems that cause billing and payment errors; assist in improvement implementation as requested.
• Accurately and efficiently distribute and/or prepare various reports; process account credit balances, refund requests, cash transfers, returned checks and unidentified payments in a timely manner.
• Accurately post payments and adjustments and balance all entries according to payer cash processing and reconciliation procedures.
• Answer questions from other staff or clinic offices by phone or e‑mail in a timely manner.
• Consistently and accurately document accounts with activities as needed in a timely manner.
• Analyze and resolve insurance correspondence for unpaid claims; validate 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.).
• Complete manual billing process for claims that cannot be sent electronically.
• Create 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.
• Generate re‑bills after all edits have been resolved and re‑submit claims to third‑party payor.
• Identify and correctly resolve all electronic claim edit failures in a timely manner.
• Identify missing or incorrect requirements of rejected claims and either resolve or forward promptly to appropriate staff for resolution.
• Monitor and complete patient accounts on billing hold for additional information within ten business days.
• Review and resolve unbilled encounter report; review Hospital cards/interface charges/electronic charge sheets, etc. for accuracy and resolve missing/incorrect information as necessary.
• Review Posting & Exception Reports and verify that information has been accurately recorded on the account receivable system.
• Comply with all policies, standards, mandatory training and requirements of Stormont Vail Health.
• Perform other duties as assigned.

Requirements

• Education: