Patient Access Financial Representative
Overview:
Under the general and direct supervision of the Patient Access Manager, our Patient Access Financial Representative is responsible for addressing patient concerns related to service and procedure charges, insurance billing and reimbursement, and all other financial transactions associated with patient accounts.
The representative provides payment options, collects patient balances as appropriate, and effectively triages, documents, and initiates referrals to Springfield Memorial Hospital's Medicaid vendor and for financial assistance, in accordance with the Illinois Fair Patient Billing Act, the Illinois Uninsured Patient Discount Act, and established procedures of Springfield Memorial Hospital and Patient Financial Services.
Additionally, the Patient Access Financial Representative is responsible for maintaining knowledge of JCAHO standards, Patient Rights and Responsibilities, HIPAA compliance, and the requirements of Managed Care, Commercial, and government payers, as well as departmental and Health System policies and procedures.
This role may also require occasional travel to other affiliate locations.
Qualifications:
Education:
- High school diploma required.
Licensure/Certification/Registry:
- Certification through Healthcare Business Insights (HBI) is required upon hire and must be maintained every two years.
Experience:
- One (1) year of business office experience is preferred, particularly in Patient Access, billing, collections, insurance principles/practices, or accounts receivable. Previous experience in Patient Financial Services is highly desirable.
- Completion of twelve (12) hours of coursework in a business or healthcare-related field may be considered in lieu of business office experience.
- Cerner systems experience is preferred.
Other Knowledge/Skills/Abilities:
- Knowledge of medical terminology, medical procedural coding (CPT), HCPCS, CCI Edits, diagnosis coding (ICD-10 CM), revenue codes, as well as UB-04 and Explanation of Benefits (EOB) interpretation.
- Proficient with computers, including the ability to enter and retrieve data, and electronically document using patient accounting software and other required applications/systems.
- Ability to work successfully with internal and external customers.
- Detail-oriented with strong critical thinking and problem-solving skills.
- Excellent oral and written communication skills, with the ability to maintain a calm and professional demeanor in high-stress situations.
- Flexible, demonstrating sound judgment and initiative in stressful situations, with the ability to manage competing priorities and work independently in a rapidly changing environment.
- Ability to educate, persuade, and negotiate effectively with patients and families.
Annual Credentialing Requirements:
- Must successfully complete assigned annual education through Healthcare Business Insights.
Responsibilities:
- Customer Assistance:
- Negotiation and Payment Collection:
Negotiate with patients and families to explain, collect, and record payments and deposits using electronic payment systems. Process cash, checks, and credit card transactions as appropriate, ensuring the accuracy and security of the cash drawer and all cash equivalents.
- Cash Reconciliation:
- Relationship Building:
- Complex Issue Resolution:
- Account Management:
- Documentation:
- Collection Activity Reporting:
- Coordination:
- Account Prioritization:
- Benefit Eligibility Analysis:
- Training and Cross-Training:
- Interpersonal Skills:
- Additional Duties:
Perform other related duties as required or requested.