PATIENT FINACIAL REPRESENTATIVE

GENERAL SUMMARY

The Patient Financial Representative is responsible for supporting departmental efficiencies and clinic front office operations by performing all aspects of insurance coverage verification, collections and reimbursement duties for services rendered in a prompt and efficient manner. The duties of this position focuses on the consumer’s financial responsibility at time of service. PFRs work behind the scenes in back‑office operations and are mainly responsible and skilled to perform duties related to consumer’s financial responsibility for services provided. Their responsibility includes, but is not limited to, performing focused reviews (pre‑audit) of scheduled and unscheduled patients’ records to determine financial eligibility, verification of insurance coverage and benefits, obtaining pre‑authorizations and identifying patient financial responsibility. The Patient Financial Representative is responsible for ensuring state funded authorizations and patient funding sources are accurately entered in the Electronic Health Record (EHR). Additionally, they employ proper compliant patient liability collection techniques before, during & after date of service; counsel patients and families on insurance, payment issues, account follow‑up and payment resolution. The Patient Financial Representative provides thorough, courteous, and professional assistance to internal and external customers in accordance with the Center’s Behavioral Principles and Core Values.

ESSENTIAL DUTIES & RESPONSIBILITIES

Essential functions are the basic job duties that an employee must be able to perform, with or without reasonable accommodation. The list of essential functions, as outlined herein, is intended to be representative of the tasks performed within this classification. The omission of a function does not preclude management from assigning essential duties not listed herein if such duties relate to the position. Completes working billing/reimbursement reports, providing proper documentation and making necessary corrections within specified times. Collects co‑pays, deductibles and other out of pocket costs and fees at the time of visit. Conducts all phases of the Revenue Cycle Pre‑Audit process 3‑5 days prior to scheduled appointments and at time of unscheduled appointments. Notates any deficiencies on appointment sheet. Conducts CBO Screenings and Referrals. Ensures all Compliance errors are reported to the Business Office Administrator and maintains records and files of documentation supporting billing changes that are directed by Business Office Administrator. Ensures quality standards are met and proper documentation regarding patient accounting records. Produces and monitors Revenue Cycle reports such as the Client Ledger and BECA reports. Verifies consumer’s insurance benefits prior to service delivery via insurance portals (TMHP, Emdeon and Novitasphere, IDX Financial Review Report, Inovolon). Sets‑up financial arrangements with patients, as necessary. Reconciles daily collections and prepares deposit logs accordingly. Sets‑up financial arrangements with patients as necessary. Serves as backup to Revenue Cycle Services functions in the clinic setting. Verifies available sessions and authorization dates. Requests insurance authorizations and/or extensions for services prior to service delivery and updates into EHR via Guarantor Submission and/or Termination form. Works correspondence and return mail. Performs other related duties as required.

MINIMUM ENTRANCE QUALIFICATIONS

Education and Experience High School diploma or GED equivalency is required. Two (2) years’ experience with medical and/or clerical office operations to include customer service, scheduling, electronic health records and insurance carrier and policy verification. One (1) year experience and excellent working knowledge of insurance verification and insurance carrier regulations, and collection requirements by payors (i.e. Medicare, Medicaid, Private Insurance, and Maximum Monthly Fee (MMF). Licenses or Certifications None. Other Requirements Experience calculating expected reimbursement according to payer regulations and/or contracts Demonstrated success working in a team environment focused on meeting organization goals and objectives required. Must maintain a valid driver’s license and automobile insurance coverage, be able to travel as needed, and be able to meet on a consistent basis the driving record requirements of the Company’s auto insurance carrier if you drive your vehicle during company business. Must maintain required credentials and mandatory training requirements to ensure compliance with all State regulations and CHCS policies. Must be able to meet the physical requirements to complete Nonviolent Crisis Intervention (NCI) and CPR training including lifting up to 12 lbs. and supporting up to 55 lbs.; bending, stooping and getting on and off the floor without assistance. Nonviolent Crisis Intervention (NCI) is a proven safe and harm‑free method of behavior modification. All consumer‑facing employees of CHCS must take NCI courses facilitated by the CHCS Training team within the first 45 days of employment. NCI is intended to support human service professionals in giving aggressive, disruptive, or out‑of‑control people the best care and welfare possible, even in the most violent situation. NCI training provides staff with the skills to safely recognize and respond to everyday crisis situations that may involve more challenging behaviors. It focuses on prevention and offers proven strategies for safely defusing anxious, hostile or violent behavior at the earliest possible stage. Depending on assigned unit/program, applicants for this position must pass a Criminal Justice Information Systems (CJIS) fingerprint‑based background check and maintain CJIS eligibility. Due to CJIS requirements related to system access, the following may result in being disqualified for this position: Felony Convictions, Felony Deferred Adjudication, Class A & B Misdemeanor Deferred Adjudication, Class B Misdemeanor Convictions, an Open Arrest for Any Criminal Offense (Felony or Misdemeanor), and Family Violence Convictions.

PREFERRED QUALIFICATIONS

Bilingual (English/Spanish) preferred. Language Proficiency Pay (LPP) payments are subject to successful testing, certification by CHCS Payroll, and availability of funding. Funding may be renewed in subsequent fiscal years but is not guaranteed.

SUPERVISION

Job has no responsibility for the direction or supervision of others. COMPETENCIES FOR SUCCESSFUL PERFORMANCE OF JOB DUTIES Knowledge of: Applicable software applications. Insurance verification claims systems and processes. Modern office procedures, methods and computer equipment. Principles and practices of recordkeeping. Principles and practices of reporting claims. System databases. Skilled in: Organization and time management. Performing a variety of duties, often changing from one task to another of a different nature. Performing basic mathematical functions such as addition, subtraction, multiplication, division, percentages, and ratios. Ability to: Accurately organize and maintain paper documents and electronic files. Effectively communicate, both verbally and in writing. Establish and maintain effective working relationships. Maintain accurate and complete records. Maintain the confidentiality of information and professional boundaries. Meet schedules and deadlines of the work. Prepare clear and concise reports. Understand and carry out oral and written directions.

PHYSICAL DEMANDS

Must be able to meet the physical requirements to complete Nonviolent Crisis Intervention (NCI) and CPR training including lifting up to 12 lbs. and supporting up to 55 lbs.; bending, stooping and getting on and off the floor without assistance. Must have adequate mobility that requires frequent walking, standing, bending, stooping, kneeling, reaching (vertical and horizontal), using fingers, hands, feet, legs and torso in various care. Monday - Friday 8:30a - 5:30p 8155 Lone Shadow Trl #J-18808-Ljbffr Center for Health Care Services