This position facilitates patient billing and collection activities, following patient accounts through the billing process to the payor, working with the payor through claims processing, ensuring reimbursement to the facility. This position may serve as a resource in complex and/or sensitive cases and may be assigned to work in any position in the department based on the departmental need.

• Provides expertise and training to Patient Financial Services Representatives. May support special projects, training staff, providing suggestions to improve processes and serving as a resource for complex and sensitive accounts.
• As assigned, processes payments, adjustments, claims, correspondence, refunds, denials, financial/charity applications, and/or payment plans in an accurate and timely manner, meeting goals in work quality and productivity. Coordinates with other staff members and physician office staff as necessary ensure correct processing.
• As assigned, reconciles, balances and pursues account balances and payments, and/or denials, working with payor remits, facility contracts, payor customer service, provider representatives, spreadsheets and the company’s collection/self-pay policies to ensure maximum reimbursement.
• As assigned, researches payments, denials and/or accounts to determine short/over payments, contract discrepancies, incorrect financial classes, internal/external errors. Makes appeals and corrections as necessary.
• Builds strong working relationships with assigned business units, hospital departments or provider offices. Identifies trends in payment issues and communicates with internal and external customers as appropriate to educate and correct problems. Provides assistance and excellent customer service to these internal clients.
• Responds to incoming calls and makes outbound calls as required to resolve billing and payment issues. Provides assistance and excellent customer service to patients, patient families, providers, and other internal and external customers.
• Reduces Accounts Receivable balances. Works as a member of the patient financial services team to achieve goals in days and dollars of outstanding accounts.
• Uses systems to provide statistical data, prepare issues list(s) and to communicate with payors accurately.

• High school diploma/GED or equivalent working knowledge.
• Requires knowledge of patient financial services, or financial collecting services or insurance industry experience processes normally acquired over three (3) or more years of work experience.
• Requires knowledge of medical terminology and a broad understanding of all common insurance and payor types and authorization requirements.
• Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently.
• Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences.
• Strong knowledge in the use of common office software, word processing, spreadsheet, and database software are required.

Preferred Qualifications

• Additional related education and/or experience preferred.