Patient Financial Services Representative - Medicaid Denials Rep

Job Description

Join a world-class academic healthcare system, Ingalls Memorial Hospital , as a Patient Financial Services Representative in the PFS Medicare and Commercial department.

This is a hybrid remote opportunity with occasional requirements to come in office as need. The office location is at our Burr Ridge, IL offices.

LOCAL REMOTE OPPORTUNITY

Job Summary

The Patient Financial Services Representative ( PFS Representative ) will be responsible for the account receivables management for Ingalls Memorial Hospital.

This position requires detailed analysis and critical thinking to determine what is necessary to ensure timely and efficient resolution of an account.

This position promotes revenue integrity and accurate reimbursement for the organization by enduring timely and accurate billing and collection of accounts.

Maintains and monitors integrity of the claim development and submission process. Acts as a liaison between patients, providers, and payers for all post-care matters related to account resolution.

The PFS Representative maintains an understanding of federal and state regulations, as well as requirements specific to Medicare, Medicaid, and fiscal intermediaries to promote compliant claims for governmental claims.

Maintains third-party payer relationships, including responding to inquiries, complaints, and other correspondence. Additionally, this individual must follow departmental productivity and quality control measures that support the organization’s operational goals.

All PFS representatives will participate in process improvement and cross-training activities on an ongoing basis.

Essential Job Functions

• Follows best practices in all patient financial services activities.
• Utilizes tools and work queues to identify and prioritize work.
• Demonstrates teamwork and integrity in all work-related activities to continually improve services and engage in process improvement activities.
• Documents all patient accounts activities concisely, including future steps needed for resolution.
• Complies with state and federal regulations, accreditation / compliance requirements, and the Hospital’s policies, including those regarding fraud and abuse, confidentiality, and HIPAA.
• Performs billing and follow-up activities for claims.
• Works daily electronic billing file and submits insurance claims to third-party payers.
• Documents billing activity on the patient accounts; ensures Hospital compliance with all state and federal billing regulations and reports any suspected compliance issues to the appropriate supervisor.
• Reviews daily edit reports from the billing system
• Prepares and submits manual insurance claims to third-party payers who do not accept electronic claims or who require special handling.
• Contacts third-party payers to determine reasons for outstanding claims and communications with payers to facilitate timely payment of claims.
• Investigates any overpayments and underpayments and Medicare bad debt reporting policies in compliance with the Centers for Medicare & Medicaid Services (CMS) guidelines.
• Serves as the hospital’s primary contact for all patient billing inquiries. Accepts inbound phone calls from patients, physician offices, and insurance carriers.
• Collects patient payments and follows levels of authority for posting adjustments, refunds, and contractual allowances.

Assist patients in understanding billing statements to ensure swift resolution.

• Reviews and processes financial assistance requests, documents approval / denials.
• Accurately post payments and adjustment, resolve credit balances, and monitor trends and compile reports for leadership, among other duties.
• Prepares, posts, and processes payment batches; posts denials, contractual adjustments, and guarantor payments within payment batches;

and ensures all payments batches are balanced.

• Reconciles bank deposit and patient accounts.
• Investigates the source of unidentified payments to ensure they are applied to appropriate accounts.
• Analyzes EOB information, including co-pays, deductibles, co-insurance, contractual adjustments, denials, and more to verify accuracy of patient balances.
• Reconciles EOB’s to make necessary adjustments.
• Determines reason for credit balances and is responsible for accurate completion and resolution of potential credit balances for health plan payers and patients / guarantors.
• Identifies and examines underpayments / unapplied credits to determine if additional payment can be pursued, or if refund is necessary;

follows up with payers and patients as appropriate.

Generates refund requests and routes the resolution to accounts payable for patients and third party payers; refunds overpayments and / or transfers payments to the appropriate account / accounts.

Responsible for correcting errors in the calculation and posting of insurance contractual adjustments

PFS Representatives will be assigned to and support one or more of the following departments :

• Billing & Follow Up - Denials
• Accounts Receivable Specialist
• Credits Department
• Medicaid / Medicare and Managed Care Billing
• Cash Applications
• Customer Service

Required Qualifications

• High school graduate or equivalent
• Hospital billing and reimbursement
• Third-party contracts
• Federal and state billing regulations
• Detailed knowledge of CMS billing guidelines and regulations for all governmental payers
• Excellent critical thinking and analytical skills
• Superior communication, organizational, and analytical skills
• Proficient organizational skills and attention to detail
• Strong interpersonal and customer service skills
• Ability to multitask and work in a fast-paced environment
• Basic knowledge of insurance processing terminology
• Ability to prioritize tasks, carry out assignments independently and within a team, and to practice good judgment

Preferred Qualifications

• Associate degree in business, healthcare, or related field required or a combination of relevant education and experience
• Two years of experience in healthcare revenue cycle, with direct experience working in Patient Financial Services
• Medical Terminology
• Proficiency in Microsoft computer programs
• Experience with Epic / Sorian
• Prior experience with billing / follow up with Behavioral Health in a hospital setting strongly preferred

Position Details

• Job Type : Full Time (1.0 FTE)
• Shift : Day Shift Monday-Friday (8am - 4pm)
• Department : Revenue Cycle - PFS Medicare and Commercial (Behavioral Health Billing)
• Office Location : Burr Ridge when required to come in office / Training is hybrid remote up to 90 days
• CBA Code : Non-Union
17 hours ago