Patient Financial Services Representative

Position Summary

The Patient Financial Services Representative supports hospital revenue cycle operations by performing patient billing, insurance follow-up, and financial counseling activities. This role ensures timely and accurate reimbursement for hospital services while providing a positive, patient-centered financial experience.

The representative works closely with patients, clinical departments, and payers to support Medicaid eligibility, billing, and financial assistance programs, helping ensure access to care for diverse and underserved patient populations.

Key Responsibilities

Hospital Revenue Cycle Operations

· Process inpatient and outpatient hospital billing, including claim submission and follow-up

· Perform payment posting, adjustments, and account reconciliation

· Monitor assigned hospital accounts receivable and follow up on unpaid or underpaid claims

· Investigate and resolve claim denials, coding issues, and billing discrepancies

· Ensure timely account resolution in accordance with hospital billing guidelines

Medicaid & Insurance Support

· Verify insurance coverage and Medicaid eligibility for hospital patients

· Assist with Medicaid enrollment, applications, and redeterminations for admitted and outpatient patients

· Submit and track Medicaid and third-party claims, including corrections and appeals

· Identify denial trends and escalate issues impacting reimbursement

Patient Financial Counseling

· Explain hospital billing processes, insurance coverage, and patient financial responsibility

· Assist patients in applying for charity care, financial assistance, and presumptive eligibility programs

· Collect required documentation and ensure completeness of applications

· Set up payment plans in accordance with hospital policies

Customer Service

· Respond to patient and guarantor inquiries regarding hospital bills and insurance claims

· Provide clear, compassionate communication, especially in high-stress hospital situations

· Resolve routine issues and escalate complex cases to supervisors

Compliance & Documentation

· Maintain compliance with hospital policies, HIPAA, and federal/state regulations

· Ensure accurate and complete documentation in hospital billing systems

· Support audit activities by maintaining proper records and following internal controls

Collaboration

· Coordinate with patient access, registration, case management, utilization review, and clinical departments

· Communicate with insurance companies and Medicaid representatives to resolve account issues

· Support discharge planning by addressing financial clearance and eligibility needs

Qualifications

Education

· High school diploma or equivalent required

· Associate’s or bachelor’s degree in healthcare administration, Business, or related field preferred

Experience

· 1–3 years of experience in hospital patient financial services, billing, or revenue cycle operations

· Experience with inpatient and outpatient hospital billing preferred

· Familiarity with Medicaid eligibility and hospital-based financial assistance programs

Skills

· Knowledge of hospital billing systems and electronic health records (EHR)

· Strong understanding of insurance processes, including Medicaid and Medicare

· Excellent customer service and communication skills in a healthcare environment

· Ability to manage multiple accounts and meet productivity standards

· Attention to detail, accuracy, and problem-solving abilities

· Ability to work in a fast-paced hospital setting