The Patient Financial Services Representative 3 performs the duties of a Patient Financial Services Representative 2 and is responsible for the timely and accurate editing, submission, and / or follow-up of assigned claims.
Processes claims for at least two payer types (i.e. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.) and ensures that all assigned claims meet clearinghouse and / or payer processing criteria.
Ensures appropriate follow-up on assigned work lists while meeting all departmental productivity and quality review standards.
Provides team management with issues regarding the claims follow-up process. Ensures that payer response reports and rejection reports are worked on in a timely and meet departmental productivity and quality review standards.
Job Responsibilities
Ensures that all clean claims are submitted the day they are received, submitted via the appropriate medium, and with all required attachments.
Reviews claims, identifies / makes corrections or initiates resolution within 24 hours of the date the claim was received.
- Documents and reports claims submission issues immediately and provides feedback to team management regarding issues and wins.
- Provides resolution for pending (WIP backlog) claims within allowable timeframes, as defined for appropriate deficiency, and / or provides appropriate account follow-up based on established protocol or SRGs.
- Completes write-off requests and submits to supervisor for daily review.
- Appropriately documents activity in HealthQuest and TRAC.
- Completes and submits all daily, weekly, and monthly reports with minimal errors.
- Maintains knowledge of payer requirements, UB-04 standards, and system (i.e. Hospital, clearinghouse, payer) functionality in addition to Hospital policies and procedures.
- Ensures documentation is professional, appropriate, accurately depicts actions performed, and is in accordance with departmental quality review standards.
- May perform additional duties as assigned.
Additional Requirements
Experience - Two years of experience in revenue cycle, finance, customer service or data analytics
Education - High School or GED
Additional Requirements : Bilingual candidates highly preferred
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