Patient Financial Services Representative

Responds to a wide variety of complex customer inquiries and those from other internal/external sources regarding patient accounts. Duties are performed via phone approximately 90% of the time and in-person directly with customers when needed.

Education:

• High School diploma or equivalent is required.

Licensure/Certification/Registry:

Experience:

• Two or more years of patient financial services experience is preferred, with the technical knowledge to independently research and resolve complex issues associated with patient accounts.

Other Knowledge/Skills/Abilities:

• Working knowledge of medical terminology, medical procedural (CPT) and diagnosis (ICD-9/ICD-10 CM) coding, and hospital billing claim form UB-04 is preferred.
• Thorough working knowledge of the PFS Representative function, with the willingness and ability to serve as a technical resource for others.
• Basic working knowledge of personal computers and associated user software is required, with the ability to enter, retrieve, and electronically notate system screens.
• Demonstrated ability to work successfully with internal customers and external contacts is required.
• Highly developed detail orientation, critical thinking, and problem solving ability are required.
• Good customer relations, listening, interpersonal, and analytical skills, and telephone etiquette are required.
• Ability to use the telephone for extended periods of time is required.
• Greets customers via phone or in-person and determines nature of inquiry. Assists customers as necessary or refers them to internal or external resources.
• Assists customers or others regarding patient account issues. Explains and coordinates the resolution of billing, private pay options, collection efforts, coordination of benefits, third party and governmental payment criteria, insurance coverage, payments, and denials. May serve as a liaison between external resources and patients on issues requiring MMC involvement.
• Develops and maintains a comprehensive knowledge of the health system organization and its functions.
• Analyzes reports containing rejected account information and performs necessary research to resolve the reason(s) for the rejection. Secures any other required information.
• Participates in the development of system edits designed to identify and ensure consistent and compliant data for patient accounts.
• Processes cash, checks and credit card transactions for payments on accounts. Maintains the accuracy and security of the cash drawer and all cash equivalents at all times. Reconciles cash and cash accounts and resolves differences.
• Utilizes computer software to create/maintain electronic customer accounts. Documents and modifies customer billing and insurance information as required.
• Generates duplicate or revised patient account invoices for services rendered. As appropriate, provides a written or verbal explanation regarding the detail contained on the invoice.
• Researches and resolves complex issues associated with patient accounts. As applicable, identifies, documents, and reports problematic trends to management.
• Ensures compliance to private insurance, governmental, and managed care contract guidelines and processes, at each work step to facilitate accurate and timely reimbursements to the organization.
• May rotate work settings to include call center, lobby, and/or other hospital environments, as assigned by management or as otherwise required.
• Serves as a technical resource to other staff in one or more areas of expertise; may provide cross training to lesser-experienced staff members as directed by manager or team leader.
• Identifies opportunities for account consolidation and takes the necessary steps to combine appropriate accounts.
• Assists with voicemail as needed.
• Performs special projects or analyses as requested by management or others.
• Serves as a backup for others during times of needs or staff absences.
• Performs other related work as required or requested.