PFS Representative I

Essential Functions

• Maintains or reduces account receivable (AR) days to meet industry standards and improve organizational cash flows.
• Bills UB04 and HCFA 1500 claims and/or self-pay patient accounts in a timely, complete, and accurate manner in accordance with appropriate guidelines.
• Provides information regarding patient accounts in response to inquiries, safeguarding confidential information in verbal replies and correspondence.
• Demonstrates understanding of the entire revenue cycle.
• Interacts with unit/department management and staff, other service areas, information systems, physicians, physicians’ office staff, patients, software/hardware vendors, and third-party payers to resolve patient concerns, disputes, and billing audits.
• Researches and analyzes any correspondence received related to assigned accounts.
• Analyzes patient accounts, determines non-collectable accounts, and recommends bad debt or charity write-offs when applicable; analyzes and processes contractual write-offs.
• Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards.
• Performs related duties as assigned.

Third Party Billing and Collections

• Reviews and resolves claim edits to ensure timely and accurate payment.
• Ensures timely and proper reimbursements by researching and resolving all aged receivables.

Self-Pay Collector

• Reviews and resolves potential coverage to ensure timely and accurate payment.
• Has a complete understanding of all options to resolve balances.
• Processes payments, sets up payment arrangements, and offers financial assistance to patients who are experiencing financial difficulty.
• Exhibits strong knowledge of fair debt collections.
• Evaluates accounts and determines payment dates based on patient's ability to pay and hospital policies; explains charges, services, and hospital privacy regarding payment of bills.
• Provides technical assistance to set up MyChart access.
• Works assigned work queues in a timely manner.

Customer Service

• Reviews and resolves potential coverage to ensure timely and accurate payment.
• Processes payments, sets up payment arrangements, and offers financial assistance to patients who are experiencing financial difficulty.
• Evaluates accounts and determines payment dates based on patient's ability to pay and hospital policies.
• Exhibits strong knowledge of fair debt collections.
• Explains charges, services, and hospital privacy regarding payment of bills.
• Provides technical assistance to set up MyChart access, and answers inquiries submitted through MyChart.
• Works assigned work queues in a timely manner.

Payment Poster

• Posts payments both electronically and manually.
• Receives, reviews, organizes, and accurately posts payments to the appropriate patient account.
• Attaches necessary documentation.
• Adjusts charge balances in accordance with Payer Explanation of Benefits (EOB) and Provider Contracts prior to posting.
• Correctly calculates adjustments and posts these to the accounts as well.
• Researches unidentified cash, resolves misdirected payments, and verifies that adjustments.
• Communicates with insurance companies, state agencies AHCCCS/Medicaid, and vendors to research outstanding payments and to retrieve EOBs.