Lead Patient Financial Services Representative

The Patient Financial Services Representative performs a variety of routine and non-routine clerical/patient accounting functions in accordance with standard procedures in one or more of the following areas: patient accounting, accounts receivable, or hospital revenue cycle for the Cherry County Hospital and Clinic.

Duties and Responsibilities

Regular responsibilities include but are not limited to the following

• Works daily electronic billing file and submits insurance claims to third-party payers
• This position is responsible for posting monies received from all payor types (including Medicare, Medicaid, Managed Care, HMO, PPO, and patient)
• Accurate billing of patient accounts, ensuring timely claim submission and reimbursement from various third- party payers and patients, ensuring proper account documentation in the facility's billing system, and pursuing follow-up efforts on aged accounts
• Reviews, evaluates, and forwards manual patient account statements to payers that do not accept electronic claims or that require special handling
• Documents billing activity on the patient account; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to CFO
• Reviews claims for accuracy and coordinates with ancillary departments as needed to provide information for audits and/or record reviews
• Based on electronic payers' error reports, makes appropriate corrections to optimize the electronic claims submission process
• Ensures payments and adjustments are accurately posted to patient accounts
• Reviews claims for accuracy and coordinates with ancillary departments as needed to provide information for audits and/or record reviews
• Based on electronic payers' error reports, makes appropriate corrections to optimize the electronic claims submission process
• Ensures payments and adjustments are accurately posted to patient accounts
• Ensures payments in correct computer log to assure accurate patient statements
• Responds to written/oral requests for itemized bill from any customer including patient, insurance company, and attorney
• Researches all patient and insurance refunds in accordance to best practice/benchmark for compliance
• Calls patients to collect on outstanding balances, collecting insurance information, or providing payment options
• Responds to patients inquiries regarding the status of insurance claims or balances due
• Visits patients in the Emergency Department or the hospital to obtain information for billing or provider Medicaid application
• Review outstanding patient balances prior to patients receiving elective services to secure appropriate payment arrangements and/or compliance with previously established payment arrangements
• Ensures timely resolution of credits by accurate and timely refunds to the appropriate entity(s) and patient(s), prepares daily deposit and control sheets
• Sorts the mail and is responsible for distribution to the appropriate area/person
• Obtains pre-authorizations for services/procedures when required by the patient’s payor
• Posts charges onto the patient account for supplies and services that were provided to the patient to ensure proper billing and reimbursement
• Various other reporting and miscellaneous reports relating to Revenue Cycle functionality, Accounts Payable or Timekeeping could be required
• Ensures the confidentiality of patients’ medical, personal, and financial records is maintained
• Knowledgeable of and committed to practicing Corporate Compliance policies and procedures
• Complies with Cherry County Hospital personnel policies
• Performs other duties as assigned by the supervisor

Lead, duties and responsibilities

• Oversee day-to-day operations of department
• Delegate tasks and set deadlines
• Set clear team goals
• Participate in recruitment and selection of team members
• Train new team members and monitor their accuracy and productivity
• Motivate and coach team members
• Identify training needs and provide coaching
• Resolve conflict; escalating as appropriate
• Provides feedback regarding job performance for team performance evaluations
• Serve as an effective role model, supporting department and organization changes
• Foster an open communication culture and inspiring team environment

Why join Cherry County Hospital?

• Supportive team environment
• Meaningful work that helps keep patient care running smoothly
• Opportunities for learning and professional growth
• Competitive pay and benefits

• If you are organized, detail-oriented, and enjoy working with people in a fast-paced healthcare environment, we would love to hear from you!
• For more information about this opportunity, please reach out to our Human Resources Department.

Requirements

Minimum Job Requirements

• High School diploma required
• 1 to 3 years of customer service and/or business office experience, ideally in a medical setting preferred
• Prior experience and knowledge in the use of software packages such as Microsoft Excel, Word, and Windows
• Knowledge of collection laws, 3rd party reimbursement, and basic hospital accounting