Patient Financial Representative

Claims Processor

FTE/Scheduled Weekly Hours: 1.00 / 40 / 1st Shift (United States of America)

Primary Functions

Responsible for the filing of claims to third party payers for services provided to insured patients, resolving errors and issues with payments and assuring correct reimbursement is obtained. Assists patients with insurance or charge related questions.

Essential Duties and Responsibilities

1. Accurately and efficiently reviews and files all types of claims for hospital inpatient and outpatient services to both primary and secondary payers. Analyzes accounts that have payer specific edits, timely filing limits, or need to be filed manually (paper claim), contacts payers and makes corrections needed to pass claims on for payment.

2. Review denied claims and claim lines, correct errors and submit corrected claims. Identify trends and help complete root cause analysis to determine actions needed to prevent future denials.

3. File appeals and reconsideration requests on partial or fully denied claims; submit documentation as required to obtain payment.

4. Follows up on unbilled and unpaid claims in a timely manner; pays attention to timely filing requirements in order to avoid write-offs. Regularly works all work queues and aging reports according to standards.

5. Thoroughly documents activities on patient accounts to provide useful information to others who may view the account and avoid incorrect or duplicate activities.

6. Resolves patient inquiries, complaints, and problems regarding their accounts or refers to next appropriate level.

7. Helps cover the workload of other team members when they need assistance or are out of the office; helps cover department workload during staff shortages.

Minimum Qualifications

Education, Experience, and Training

• High school diploma or equivalent.
• Minimum of two years medical insurance experience is preferred.
• Basic knowledge of CPT codes and modifiers is preferred.
• Strong organizational skills.
• Strong oral and written communication skills.
• Ability to learn and navigate computer systems including the online training modules, the employee timesheet and the performance appraisal system. Job specific systems are also required.
• Able to read, speak, and write fluent English.

Physical Requirements

• Sitting – Approximately 100% of shift.
• Standing – Not a requirement.
• Walking – Not a requirement.
• Lifting – Not a requirement.
• Twisting – Not a requirement.
• Bending – Infrequent.
• Squat/Kneel – Not a requirement.

Work Environment

1. May come in contact with hazardous chemicals or treatment modalities.

2. The possibility exists of exposure to communicable disease due to working in a healthcare environment.

3. Involvement in patient care may result in unavoidable work-related illnesses.