The Patient Financial Services Representative 4 performs the duties of a Patient Financial Services Representative 3 and is responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims. Processes claim for multiple payer types (i.e. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.) and ensures that all assigned claims meet clearinghouse and/or payer processing criteria. Ensures appropriate follow-up on assigned work lists while meeting all departmental productivity and quality review standards. Informs management of issues and potential resolutions regarding problems with the claims process. Provides support, education, and guidance to team members while performing duties, as assigned, in the absence of the supervisor or manager.
Job Responsibilities
- Ensures that all clean claims are submitted the day they are received, submitted via the appropriate medium, and with all required attachments. Serves in the place of the supervisor or manager in their absence.
- Resolves complex issues either through individual actions or by coordinating information/actions of other team members, Patient Accounts staff, other hospital departments, or at the payer level. Seeks assistance from supervisor when needed.
- Ensures that claims are reviewed, corrections are identified/made or resolutions are initiated within 24 hours from the date that claims are received. Identifies the need for and provides support/guidance to other team members to promote their efficiency and productivity.
- Handles complex and/or highest dollar accounts while providing appropriate follow-up based on established protocol or SRGs.
- Ensures appropriate and timely documentation of all account activity while appropriately handling all correspondence within 48 hours of receipt.
- Documents activity in HealthQuest and TRAC and ensures that documentation is professional, appropriate, accurately depicts actions performed, and is in accordance with departmental quality review standards.
- Works payer response reports and rejection reports while ensuring they meet departmental productivity and quality review standards. Maintains knowledge of payer requirements, UB-92 standards, system (Hospital, clearinghouse, payer) functionality, and hospital policies and procedures.
- Takes direction from management to resolve issues in addition to providing support, education, and guidance to team members. Performs duties, as assigned, in the absence of the supervisor or manager.
- May perform additional duties as assigned.
Additional Requirements
Certification - Not requiredLicensure - Not requiredExperience - 3 years of Experience in revenue cycle, finance, customer service or data analyticsEducation - Associate Degree or an additional three years of experience appropriate to the position under consideration.
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Inova Health System
Nov 11, 2024