Patient Financial Services Representative

Description

Description

The Patient Financial Services Representative is responsible for the review of the patient financial information and the communication with the patient and/or responsible party regarding any third-party reimbursement coverage and/or the portion due from the patient for healthcare services. The representative will complete a social and financial assessment and appropriately refer patients who have no insurance coverage or qualify for financial assistance to a medical eligibility agency for potential assistance through federal, state, or local healthcare programs.

The representative will respond to all incoming financial-related inquiries including billing, explaining EOBs, fielding patient calls, applying adjustments, and accepting proposals/negotiations. Reports directly to the Patient Financial Services Supervisor.

Duties include but are not limited to:

• Reviews accounts to determine insurance coverage.
• Fields incoming calls and addresses all finance/billing related inquiries.
• Interviews the patient and/or responsible party to obtain any missing insurance information.
• Evaluates the need for financial assistance and discusses the patient’s financial responsibility.
• Responsible for the entry or update of insurance information on the patient’s account and assists in maintaining the insurance database.
• Refers account for insurance verification and benefit coverage to the Insurance Verification staff in a timely manner.
• Identifies patient with no third-party reimbursement and/or with financial assistance needs and communicates with the patient regarding potential sources for financial assistance.
• Makes timely referrals to the medical eligibility agency to explore all available assistance and help in qualifying and filing for eligible programs.
• Based upon the evaluation of ability to pay, collects from the patient or responsible party the patient portion, or establishes payment arrangements within hospital guidelines.
• Properly documents all pertinent financial information and efforts in the account comments.
• Uses best judgment to resolve patient problems or refer issues to the department supervisor.
• Remains current on knowledge of Medicare, Medicaid, Managed Care Contracts, and compliance regulations, as well as system and department processes. Complies with and supports department and organization policies and procedures.
• Responsible for the collection of payments or setting up payment plans prior to services being rendered, at time of admission, or during the discharge process.
• Seeks out relevant training or cross-training from supervisor; seeks guidance from supervisor and teammates when uncertain of procedure; solicits feedback from the supervisor to assess quality and effectiveness of work; participates in dialogue with supervisor regarding quality improvement; demonstrates a commitment to continuous quality improvement.
• Other duties as assigned by Supervisor.

Education: High School Diploma required. An associate degree preferred.

Experience: Minimum of one (1) to three (3) years of experience working with patient accounting, insurance verification and precertification, financial counseling, and medical terminology. Previous experience in customer service, managing inbound calls, and patient collections within a healthcare setting is preferred.

Language

Skills:

Demonstrated ability to exercise professional oral and written communication skills with all internal and external audiences.

Computer

Skills:

Experience with medical billing software systems is required. Strong Microsoft Excel skills are required. Proficiency in Microsoft Outlook, Word, and PowerPoint is also required.

Reasoning Ability: Ability to organize and manage personal workload and the workload of assigned direct reports and associated teams. Ability to maintain strong knowledge of anesthesia billing operation practices. Ability to analyze and assess production efforts. Ability to work in a fast-moving environment, drive toward clarity and solutions, make quick decisions, and develop and execute corrective action plans.

The physical demands described here are representative of those that must be met by any employee to successfully perform the essential functions of this job. Hybrid-based position, requiring two to three days in the office, with standard working hours. While performing the duties of this job, the employee is regularly required to sit, stand, walk, use hands to finger, handle, or feel, reach with hands and arms, and talk or hear.

The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally be able to work in a standing position for long periods of time. Travel is primarily local during the day, although some out-of-area and overnight travel for conferences may be required.

Headquartered in Charlotte, North Carolina, Providence Anesthesiology…