Patient Financial Services Representative I

Full time (40 hours weekly)
Monday-Friday dayshift
General Summary
Completes assigned revenue cycle tasks. Assists in the completion of submitting electronic and/or manual insurance claims, resolves claim edits, performs insurance account follow-up, researches claim denials for resolution and submits disputes and appeals when necessary. Represents the System in a professional manner while interacting with peers, leaders, patients, and third-party payers to achieve timely payment on accounts in accordance with current government and payer regulations.
Duties and Responsibilities
Essential Functions:

• Conducts timely follow-up on patient accounts billed to insurance companies to determine reasons for delayed or missing payments.
• Investigates denied or rejected claims, reviews insurance remittance advice, and identifies reasons for denial.
• Collaborates with insurance carriers, internal billing teams, and other stakeholders to obtain necessary information and documentation to resolve claims.
• Documents findings and actions taken to resolve denials or delays in payment.
• Initiates and manages appeals or resubmissions of denied claims as appropriate.
• Communicates effectively, verbally and in writing, directly with payors to follow up on outstanding claims, files technical and clinical appeals. Resolves payment delays/non-payments to ensure timely and accurate reimbursement.
• Maintains accurate records of follow-up activities and payment status in the billing system.
• Identifies trends in denied claims and recommends process improvements to reduce denials and expedite payment.
• Provides excellent customer service to patients and internal teams regarding billing inquiries and insurance follow-up.

Common Expectations:

• Maintains appropriate records, reports, and files as required.
• Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards.
• Participates in educational programs and in-service meetings.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

• High School Diploma or GED Required
• Associates Degree Preferred

Work Experience:

• 1 year Required
• Prior experience in hospital billing, professional billing, or insurance follow-up/denials Preferred

Knowledge, Skills, and Abilities:

• Knowledge of insurance claims processing, payer policies, and medical terminology is essential
• Strong analytical and problem-solving skills to investigate and resolve billing discrepancies
• Excellent verbal and written communication skills for effective interaction with insurance companies and internal teams
• Proficiency with billing software and Microsoft Office Suite (Excel, Word, Outlook)
• Ability to manage multiple accounts and prioritize tasks efficiently in a fast-paced environment
• Attention to detail and commitment to accuracy

Benefits Offered:

• Comprehensive health benefits
• Retirement savings plan
• Paid time off (PTO)
• Education assistance
• Financial education and support, including DailyPay
• Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)