Patient Financial Services Specialist II

About the role

Performs a variety of patient accounting functions including insurance billing, self-pay billing, remit analysis & cash posting, accounts receivable management, claims follow up, charge validation and analysis, denials analysis & resolution and tasks to support the Consortium’s month end close processes.

Responsibilities

• Validates changes and billing information.
• Validates proper charge codes, billing, and adjudication of claims in accordance with standard federal, state, and private billing policies and reimbursement principles.
• Stays current on changing payor-specific charging and billing rules.
• Affords assistance with other special projects related to billing/rebill projects.
• Identifies, analyzes, and reconciles billing errors or omissions.
• Provides service to customers, answering questions and resolving issues.
• Answers patient billing questions and takes necessary action to resolve the account.
• Validates balance, bills and follows-up on patient self-pay accounts consistent with the Consortium’s discount, bad debt and charity policies.
• Lets patients know of delinquent accounts by mail or telephone, and arranges for debt repayment.
• Collaborates with financial counselors to identify alternative funding sources for patients.
• Reconciles payments.
• Logs all transactions posted to the organization’s bank account into the cash log and allocates all monies to the appropriate EHR system or identifies as a general ledger transaction.
• Communicates effectively with the cash posting team and participates and contributes constructively to produce results in a cooperative effort to ensure that all funds are processed, scanned, and batched for posting within established service levels.
• Processes incoming mail.
• Prints, scans, and organizes correspondence such as EOBs, letters, and denials.
• Downloads back-up for clinic deposits in the PFS shared drive folders.
• Logs denials and works closely with billing to ensure proper follow up.
• Enters account history notes when necessary for billing team follow up.
• Hands off other correspondence to proper staff for follow up.
• Facilitates insurance and patient refunds and ensures all back-up is scanned into refund log.
• Assists in communication of strategies or messages from senior leadership.
• Cash Posting & ERA Management: Accurately posts all cash, checks, credit cards, and electronically transferred funds to beneficiary and non-beneficiary accounts within 3 business days of cash deposit or escalate non-postable deposits for resolution.
• Researches and resolves un-applied cash and misapplied payment research requests.
• Balances all transactions posted to source system and daily batch deposits.
• Deciphers Explanation of Benefits (EOB) and balances transfer money to the secondary insurance or patient liability.
• Solves rejected electronic transactions and assists with the identification and implementation of new payers for electronic transactions; posts incoming claim denials and work closely with the billing/denials team to document within denials log and ensure proper follow up and appeals.

Requirements

• High school diploma or equivalent – required.
• Associates degree in related field – preferred.
• Certified CRCR (HFMA-Medical), CRCS (AAHAM-Medical), or CDBS (ADCA-Dental).
• Current employee must be in good standing to qualify for employer-paid certification.
• Two years of experience in billing, collections and/or cash posting – required.
• Knowledge of hospital or clinic billing and follow up and medical terminology.
• Knowledge of payor remittances and basic knowledge of CPT’s, HCPCS, and Revenue Codes.
• Knowledge of major insurance companies' billing policies to ensure compliance and insurance claim forms.
• Knowledge of specific specialties within the hospital or clinic billing area.
• Knowledge of reconciling and balancing of payments received against account receivables.

Qualifications

• In Using a keyboard and 10-key.
• Problem solving, decision making and detail orientation.
• Verbal and written communication.
• Ability to Collaborate within cross-functional teams.
• Work in a fast-paced setting.