Patient Services Representative

Collections Specialist

Responsible for all duties involved with the follow-up and prompt collections of inpatient and outpatient account balances; ensures that claims are adjudicated timely and appropriately for payment or denial by payers. Time frames are specific and must be adhered to so that reimbursement is received timely. Responsible for telephoning patients and/or insurance companies to resolve account balances.

Minimum Qualifications:

• High school diploma or equivalent
• Proficient computer skills, as well as all office equipment
• Ability to efficiently and effectively work with insurance companies, patients/patient representatives, and other STHS Departments
• Strong analytical and problem-solving skills
• Familiar with payment methodologies including fee schedules, per diems, case rates, case mix and carve outs
• Possess knowledge of current billing guidelines and can research via resources such as CMS website, MLN, LMRPs, payor websites, CCI editor, MUE editor
• Resolve both denial and discrepancy issues in claim payments by insurance payers
• Ability to communicate effectively and professionally, both verbally and in writing
• Use Microsoft Office in performance of duties and responsibilities

Preferred Qualifications: 1 year insurance collections/follow-up experience preferred in a medical clinic, hospital facility, revenue cycle, registration, financial counseling, or other healthcare entity. Use of EPIC and/or nThrive billing systems.

Physical Demands: Must possess good physical health. Some requirements include but are not limited to standing, sitting or walking for long periods of time. Lifting at least 20 pounds is required. Physical Effort required: Constant (67%-100%) talking, hearing, seeing Frequently (34%-66%) NONE Occasionally (1%-33%) - lifting, carrying, pushing/pulling, climbing (stairs, ladders, poles, etc.), balancing, crouching, crawling, reaching, handling/feeling