Patient Financial Services Representative II

Patient Financial Services Representative II

ANCHORAGE, AK 99503

Position Summary

Responsible for handling complex daily tasks within the revenue cycle. The PFSR II is expected to have a proficient understanding of coding, denial management and appeals, payment processing, coordination of benefits, and the prioritization and sequencing of payers, contracts, and exclusions. Responsibilities include daily auditing, coding, revenue recovery, and the preparation and submission of insurance claims. Communicates effectively with management about problem areas and suggests potential solutions. Must be able to thrive under pressure to meet deadlines in a fast-paced environment and be available for extra hours, including weekends, as needed.

Essential Duties and Responsibilities

• Perform detailed reviews of patient accounts, applying knowledge of medical, dental, laboratory, radiology coding and billing standards to ensure precise account management.
• Receive, evaluate, and input new health care claims into the system. Process payments and apply denials or returns according to policy, ensuring compliance and accurate classification of claims.
• Accurately post payments and adjustments from third-party payers, including Medicare, Medicaid, and Workers' Compensation, maintaining data integrity and clear account records. Communicate patient financial obligations, including copays, coinsurances, deductibles, out-of-pocket maximums to ensure understanding and accurate applications during billing.
• Audit and post charges across multiple departments, (e.g. evaluation and management, surgery, radiology, laboratory, behavioral health, and dental) ensuring accuracy in charge capture.
• Identify research and resolve denied/unpaid claims, submitting corrections, and filing appeals timely to recover revenue effectively. Maintain accurate records of denial reasons, actions taken, and resolution outcomes.
• Independently solve complex account issues by applying technical billing standards, working to resolved discrepancies and optimize reimbursement processes.
• Run routine and ad hoc reports, including those for unapplied credits, insurance aging, claim holds, pending charges, and work-in-progress (WIP) accounts, supporting financial tracking and reporting.
• Identify and correctly post suspense accounts and unidentified payments, maintain proper documentation for a clear audit trail.
• Ensure all claims and billing activities align with payer guidelines, third-party reimbursement, and in-network vs. out-of-network rules to maximize compliance and support revenue cycle management. Work closely with providers, nursing staff, care coordinators, and eligibility personnel, to ensure smooth patient care and support for optimize billing processes.
• Adhere to HIPAA guidelines and all relevant regulations, ensuring confidentiality and security of patient information during all billing activities.
• Attend regular team meetings, engage in training sessions, and participate in Continuous Quality Improvement (CQI) programs to stay informed on billing practice and enhance the efficiency of denial management.
• Address patient and payer inquiries promptly, providing clear answers regarding billing and account details to support positive relationships and customer satisfaction.

Supporting Duties and Responsibilities

• Mentor Patient Financial Service Representative I (PFSR I).
• Multi-task and able to provide back-up coverage for all (PFSR I & II).
• Perform other job-related duties as assigned.
• Maintain a clean and orderly work area.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

Work Experience: Three to five years of experience in the medical billing field is required. Relevant experience in revenue cycle management or a similar healthcare setting may substitute for formal education requirements.

Education, Certification and Licensure: Requires a high school diploma or equivalent, along with medical billing training. Preferred certifications include CPC, CBC or other AAPC certifications, which may substitute for relevant experience.

Additional Skills & Knowledge: Possess workable or in-depth knowledge of medical coding standards, including ICD-10, CPT, HCPCS, NDC and CDT. Should be able to accurately identify diagnoses, procedures, and services to ensure compliance with billing standards and maximize reimbursement. Strong familiarity with coding guidelines and payer-specific requirements is essential. Proficiency in using a ten-key, strong attention to detail, and excellent attendance are required. The employee must also possess analytical and critical thinking skills to solve billing issues, effective time management, technical proficiency in billing software, and be dependable and adaptable in a fast-paced environment. Exceptional customer service skills are essential for delivering high-quality support and addressing billing inquiries professionally.

Physical, Sensory, Environmental Qualifications:

While performing the duties of this job, the employee is regularly required to remain sedentary for prolonged periods of time at a workstation, may involve walking and standing for brief periods of time. Occasionally will exert up to 20 lbs. of force to move objects and files. Must be able to work under pressure to meet deadlines within assigned timeframe. Must be able to work occasional evenings and weekends.

Work is performed in a healthcare clinic and office setting. ANHC is a tobacco-free campus.

Equal Employment Opportunity Statement:

Anchorage Neighborhood Health Center provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Anchorage Neighborhood Health Center complies with applicable state and local laws governing non-discrimination in employment in every location in which the organization has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Persons alleging unequal treatment should contact the Chief Human Resources Officer.

The undersigned have read this job description and agree that it defines the position as it currently exists. The undersigned also understands that the above is intended to describe the general content of and requirements for this job. It is not to be considered as an exhaustive statement of duties, responsibilities, or requirements and does not limit the assignment of additional duties at the discretion of the supervisor.

Anchorage Neighborhood Health Center