Patient Financial Services Specialist

Essential Duties & Responsibilities

• Utilizes the Epic Hospital Billing System to review and monitor accounts through the Billing, Denial, & Follow-Up work queues
• Work assigned accounts with higher complexity (high dollars, specific denial records, etc) within Hospital Billing, Denial, & Follow Up various work queues while maintaining established productivity requirements
• Contact insurance carriers or other responsible parties to confirm payment dates, question why a claim was denied or questions why a claim was not processed for payment or denial
• Performs all Hospital Billing, Follow-Up, and Denial activities necessary to obtain payment/resolution of claims
• Review the entire account to ensure claims were billed properly, payments were applied correctly, and all necessary adjustments were made before moving to the next responsible party and/or adjusting balances and removing them from work queue(s)
• Gather all necessary documentation needed to have claims reprocessed/adjudicated
• Informs and/or transfers to management of any problem accounts and or denial trends that require escalation within 2 days of identification
• Documents all actions taken within the EPIC account notes section and/or follow up/denial activities note sections
• Adheres to all Hospital Billing, Follow up, and Denial departmental policies and procedures/training documents
• Complete necessary training sessions required for the Hospital Billing system and demonstrate good working knowledge from those sessions to successfully resolve assigned accounts within Follow Up and Denial work queues
• Document all inactive periods and make them available upon management's request
• Solves accounts with higher complexity in any Claims Edit work queue and resubmits claims through the Epic Billing System
• Works higher level of complexity specific claim edit work queue(s) daily and resubmit claims through the Epic billing system
• Handles Paper claims processing including proper documentation of accounts with higher level of complexity
• Communicates all claims/data problems that cannot be handled to the Supervisor/Manager within one (1) day of identifying the problem
• Identifies and researches all incomplete or inaccurate information on claims, demonstrates proper handling and escalation as needed
• Handles payer 277 rejections on accounts with higher level of complexity and resubmits claims through Epic Billing system or other means of submission (i.e., email, fax, payer portal, certified mail)
• Provides trends to management for payer outreach and/or internal billing system updates to ensure timely filing and reimbursement

Minimum Qualifications

• Education: High School Diploma / GED Required
• Licensure, Certification & Registration: None Required
• Experience: At least five (5) years accounts receivable experience required
• Skills, Knowledge & Abilities: Demonstrates excellent attention to detail and prioritization of accounts; Demonstrates strong working knowledge of Epic Hospital Billing Follow Up and Denial workflows, considered as Subject Matter Expert (SME) to team and other colleagues; Demonstrates Clear oral and written communication; Demonstrates Professional telephone & email etiquette; Demonstrates the ability to interact with insurance carriers, patients, and co-workers in a professional and helpful manner; Demonstrates higher level use of billing computer and PC skills; Demonstrates a higher level of problem solving and decision making skills; Demonstrates ability to resolve account issues to completion and obtain appropriate payment; Demonstrates the ability to work independently and efficiently

Preferred Qualifications & Skills

• Experience in Revenue Cycle Accounts Receivable
• Experience working with EPIC Pay Range: $22.05 - $29.68