Job Summary

Supports, and is responsible for incorporating into job performance, the Frederick Health (FH) mission, vision, core values and customer service philosophy and adheres to the FH Compliance Program, including following all regulatory requirements and the FH Standards of Behavior.

The Patient Financial Service Rep ensures patient charges and payments are correct, insurance authorization has been obtained and timely submission of the account to achieve payment from third party payer or the patient.

Demonstrates a high level of accuracy considering the volume and filing requirements of the various insurance payers. Also recognizes the priorities of the work to be completed in order to maximize efficiency.

Example of Essential Functions :

• Examines denied and underpaid claims to determine reasons for discrepancies
• Communicates directly with payers to follow up on outstanding claims, resolve payment variances, and achieve timely reimbursement
• Provides payers with specific reasons for suspected underpayments and analyzes denial reasons given by payers
• Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing A / R
• Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, in order to identify and report billing compliance issues and payer discrepancies
• Updates and maintains accurate files on each payer, including contact names, addresses, phone numbers, and other pertinent information;

thoroughly documents all interactions with payers

• Effectively handles all communications, including telephone and email, from payers and departments within the business office
• Utilizes payer scorecards, identifies high-risk accounts, and prioritizes follow-up efforts
• Participates in continuous quality improvement efforts on an ongoing basis, establishing goals with supervisors and tracking progress
• Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management
• Understands and maintains compliance with HIPAA guidelines when handling patient information
• Receives and processes all types of patient payments by properly documenting and entering transactions into the system;

posts payment promptly

• Prepares individual bank deposits accurately and in a timely manner; checks with the bank for any direct deposits
• Prepares, posts, and processes payment batches; posts denials, contractual adjustments, and guarantor payments within payment batches;

and ensures all payment batches are balanced

• Reconciles cash receipts and patient accounts
• Investigates the source of unidentified payments to ensure they are applied to appropriate accounts
• Identifies and examines underpayments to determine if additional payment can be pursued; follows up with payers and patients accordingly
• Identifies and examines unapplied credits and other overpayments to determine if a refund is necessary; issues refunds promptly as appropriate
• Records appropriate, up-to-date notes in patient accounts, and provides insurance collectors accounts for follow-up
• Analyzes EOB information, including co-pays, deductibles, co-insurance, contractual adjustments, denials, and more to verify accuracy of patient balances
• Reconciles shortages on both paper and electronic EOBs to determine proper allowance and correct write-off
• Transfers balances to self-pay or secondary insurance
• Handles telephone questions and concerns from customers; ensures complaints and inquiries are recorded and reported to management
• Utilizes the safe to deposit large bills and sums of money from the cash drawer; keeps minimum allowable amount in drawer at all times
• Balances cash register / box daily or as instructed
• Demonstrates exceptional guest relations by promptly answering phone calls and answering patient questions
• Complies with all organizational policies regarding ethical business practices
• Performs other duties as assigned

Required Knowledge, Skills and Abilities :

Strong analytics, communication and organization skills and 40 wpm typing speed are required.

Minimum Education, Training, and Experience Required :

• High School diploma or GED is required.
• One year of experience working in a hospital or physician collections / centralized billing function is preferred.

Physical Demands :

Sedentary - Light Work - Lifting up to 15 pounds on an infrequent basis (less than one lift every three minutes). While work is mostly done sitting, a certain amount of walking or standing is often necessary.

Ergonomic Risk Factors :

Repetition : Repeating the same motion over and over again places stress on the muscles and tendons. The severity of risk depends on how often the action is repeated, the speed of the movement, the required force and muscles involved.

Awkward Posture : Posture is the position your body is in and its effect on the muscle groups that are involved in the physical activity.

Awkward postures include repeated or prolonged reaching, twisting, bending, kneeling, squatting, working overhead with your hands or arms, or holding fixed positions.

Working Conditions :

A. Bloodborne Pathogens Exposure Risk : Category C NO exposure to blood or body fluids.

Reporting Relationship :

Reports to Supervisor, Patient Accounting

Last updated : 2024-05-26