The Patient Financial Services Account Service Representative will perform administrative duties as it relates to the fiscal needs of the patients that we service. The PFS-ASC will perform a variety of tasks related to patient needs and any relevant paperwork required to be completed in a timely manner. The PFS-ASC is responsible for reviewing insurance processing for accuracy, reviewing patient statements to determine if payment and adjustments were applied appropriately and completing paperwork related to financial assistance, billing record requests, and insurance processing. Meet with patient or contact patient to confirm that they understand their patient statement, to determine patient financial assistance needs for medications or charitable care.
Qualify Patients for Financial Assistance. Working with all pure self-pay patients and insured patients who are responsible for a balance after insurance to gather, review, and evaluate the necessary and pertinent information regarding patient income and assets, and establish access to and utilization of government health coverage and/or charity care.
Facilitate Financial Clearance. Facilitating the creation of individualized monthly installment plans for patients to pay off balances within the guidelines of the Tidelands Health collection policy.
Utilize appropriate means to effectively communicate with customers. Utilizing a series of methods, including face-to-face meetings, telephone, and electronic/standard mail to establish and maintain contact with patients/guarantors.
Document within Meditech, Quadax, eCW, Charity Guide or Verge. Employee should fastidiously record and maintain complete documentation of all activities performed on patient accounts in a timely manner.
Utilize Charity Guide as a resource to progress Financial Assistance applications in a timely manner. Monitoring progress of applications to ensure adherence to application completion and processing timelines.
Utilize Quadax, various payer websites and Meditech to validate insurance billing and processing occurred in a timely and appropriate manner. Review and resolve issues related to insurance processing to include, but not limited to, reviewing explanation of benefits from insurance payers, reaching out to denials team members for review of denials and/or rebilling of claims related to revision of order for services.
Work in conjunction with various Tidelands Health vendors to resolve customer inquiries and grievances within a timely manner. Review of worklists from various vendors related to patient accounts questions regarding payment plans, paying off accounts or employee account payment, as necessary.
Work with various department heads to resolve charge related complaints as well as the Patient Advocate to resolve quality of care grievances. Upon completion of department head and/or patient advocate review process appropriate rebill or adjustment necessary and contact patient to offer timely and effective resolution of their concerns.
Assist with Patient Payment Portal Enrollment. When needed provide personal assistance to patients who express interest in enrolling in the patient payment portal.
Report any repetitive issues to Assistant Director of PFS. Remaining in communication with manager regarding high-risk accounts and workflow trends and fluctuations.
Education (must meet one of the following):
Associates Degree in Business related field and a minimum of three years healthcare experience preferred OR
High School Diploma with a minimum of five years healthcare experience.
Two (2) or more years of experience and/or knowledge with the following:
Patient financial counseling, patient customer service, scheduling, or prior authorization.
Detailed knowledge of third-party payor regulations related to managed care, denials, and reimbursement issues.
Terminology for hospital or physician billing.
CPT and ICD-10 coding.
Prior experience with interpreting and following detailed policies and workflows.
Prior experience with Meditech, E-Clinical Works software program, Aria for Oncology services, Charity Tracker and Microsoft Office preferred.
Accredited Financial Counselor (AFC), preferred.
Certified Revenue Cycle Representative (CRCR), preferred.
Ability to negotiate point of service payment.
Ability to review and explain insurance processing per explanation of benefits when necessary.
Ability to rebill insurance claims when necessary.
Demonstrated ability to exhibit exemplary core customer skills at all times.
Independent decision-making skills, collaborative abilities, and organizational and time management skills.
Incumbent must have the ability to work evenings, as needed.
Physical Requirements: Light Physical Agility Test (PAT) Rating
While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert up to 15 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or up to 5 pounds of force frequently, and/or a negligible amount of force constantly to move objects.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.