Patient Financial Services Representative III

Billing And Collection Specialist

This position is responsible for billing and collection of accounts receivable for inpatient and outpatient accounts, ensures expected payment is collected and accounts are fully resolved, and resolves complex customer service issues. This position understands the importance of evaluating and securing all appropriate financial resources for patients to ensure proper adjudication.

Responsibilities

• Intentionally prevents untimely revenue shortfalls by taking action to resolve financial transactions appropriately and effectively to ensure collection of expected payment; escalates issues when appropriate.
• Completes daily work assignment timely and accurately in accordance with the identified productivity and quality standards set forth by the organization.
• Performs the best practice routine per department guidelines.
• Proactively looks for continuous process improvements involving people and technologies through tracking, trending, and providing feedback.
• Accelerates business outcomes by identifying ways to fully resolve accounts through single-touch resolution when possible.
• Understands revenue cycle and the importance of evaluating and securing all appropriate reimbursements from insurance or patients.
• Contacts payers via portal or provider service center to facilitate timely and accurate resolution of accounts.
• Responsible for processing external correspondence in a timely and efficient manner.
• Ensures internal correspondence is clearly and professionally communicated and processed expeditiously.
• Responsible for verification of insurance and/or patient demographics
• Understands expected payment amounts and Epic expected payment calculations to appropriately adjust accounts.
• Educates patients and/or guarantors of patient liability when appropriate.
• Understands and complies with all relevant laws, regulations, payer and internal policies, procedures, and standards, and applies this understanding through daily work
• Responsible for processing accounts through multiple workflows
• Responsible for working accounts requiring more attention to detail
• Advanced knowledge of team procedures, standards, and policies, and applies this knowledge through daily work.
• Makes appropriate contacts with payers and other necessary parties to obtain and/or provide data or information needed to facilitate timely and accurate account resolution to expedite outcomes.
• Utilizes strong understanding of multiple systems/applications to ensure collection of expected payment.
• Utilizes knowledge of internal and external departmental functions and workflows to expedite and resolve when necessary.
• Responsible for in depth investigation and resolution of complex accounts
• Utilizes public speaking skills through high engagement in discussions and meeting facilitation.
• May be assigned complex responsibilities/projects that require senior leadership visibility or approval.
• Acts as a key resource to the team by mentoring staff and/or supporting the lead.
• Responsible for detailed analysis and processing of correspondence to facilitate improved collection processes.
• Maintains, complies, and shares knowledge of all relevant laws, regulations, payer and internal policies, procedures and standards.
• Extensive knowledge of other areas within the department to provide support as needed.
• Follow-up/Billing
• Dependent on knowing denial/rejection codes, insurance guidelines and compliance.
• Customer service (mini call center)
• Maintains the best practice routine per department guidelines.
• Dependent on knowledge of phones, insurance guidelines, collection processes, personal skills for dealing with customer, Self-pay/Collections de-escalations tactics, payment research
• Timely processing and follow-up of patient requests for payment research, checking charges, insurance processing concerns.
• Work independently in problem solving with patients regarding their account.
• Demonstrate a high degree of proficiency in billing and/or collection of multiple payers (both government and non-government) billing and collection practices.
• Responsible for the analysis and processing of correspondence including rejections, requests for medical records, itemized bills, clarification of detail on bill, etc. Analyze paid claims for accuracy of payments and or rejections and properly account for payment and adjustments by both payers and patients.
• Reviews explanation of benefits for accuracy in posting and assisting patients in understanding their patient liability.
• Identify problem accounts and work towards timely resolution.
• Communicate effectively via the telephone or written communication with patients or departments to obtain and provide all information for payers to process and pay claims quickly and accurately.
• Bad debt management of accounts and interactions with vendors.
• Counsel patients throughout the collection process on solutions available to them for account resolution.
• Problem solve with vendors and patient on reasonable resolutions.
• Refunds
• Patient
• Insurance
• Confirming of sales orders (100% quality review) - Dependent on payor guidelines, compliance, and knowledge of equipment
• Authorizations - Dependent on payor guidelines
• Verifications Dependent on OneSource (Experian), payor portals

Required Qualifications

• 2 years in a medical billing office setting or relevant experience
• 2 years or more of billing experience working with insurance companies
• Organizational skills
• Communication skills
• Attention to detail
• Ability to problem solve and able to utilize resources independently

Preferred Qualifications

• 2 years of medical billing office setting experience
• MS Office experience
• Coordination of benefits experience
• Epic, Brightree, Billing Bridge, or comparable software account experience
• Experience working with medical terminology
• Experience working with CPT-4 and ICD-10
• Extensive knowledge of FV account review experience
• Extensive knowledge of FV system applications
• Extensive knowledge of FV RCM workflows
• Billing certification
• Substantial system super user experience

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more!

An individual's pay rate within the posted range may be determined by various factors, including skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization prioritizes pay equity and considers internal team equity when making any offer. Hiring at the maximum of the range is not typical. If your role is eligible for a sign-on bonus, the bonus program that is approved and in place at the time of offer, is what will be honored.

EEO/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status