PFS Billing Representative | Full Time | Day

Billing Operations

Prepare, review, and submit electronic and paper claims to insurance carriers and government payers depending on assigned team. Ensure claims are compliant with CMS, Medicare, Medicaid, and commercial payer guidelines as appropriate for team. Monitor claim status and resolve claim edits, rejections, and denials in a timely manner. Submit corrected claims and appeals as needed. Account Management - Follow up on unpaid, underpaid, or denied claims as assigned. Research and resolve billing discrepancies. Prepare and submit appeals with appropriate documentation. Document all actions and activities taken in the billing system. Maintain productivity and quality benchmarks. Timely and accurate management of all assigned work Queues.

Customer Service

Respond to insurance inquiries regarding claim processing/issues. Provide clear, professional communication to all customers while maintaining patient confidentiality. Provide accurate, timely feedback to Patient Account Resolution staff regarding patient inquiries.

Compliance

Adhere to HIPAA regulations and hospital policies. Maintain confidentiality of protected health information (PHI). Stay current on payer updates, state and federal billing regulations, and reimbursement procedures.

Teamwork

Collaborate with team members on a daily basis by sharing information and assistance as needed. Assist with team members' responsibilities in their absence. Works cooperatively to resolve billing issues with other teams including but not limited to: Provider Offices, Patient Account Resolution, Hospital Departments and Registration.

Technology

Up to date knowledge of systems used by PFS to include but not limited to: Cerner, payer websites, Availity, MMIS, Connex, FISS, FinThrive, Policy Tech and Microsoft Office Products as applicable.

Work Environment

Training in office is required. Once trained there are a variety of options depending on skill, training and hospital requirements: in office, at home or hybrid (mix of in office and home). May require occasional overtime to meet billing deadlines.