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Patient Financial Representative Senior

1 month ago

San Antonio, Texas, United States Sigma Full time
Job Title: Patient Financial Representative Senior

At Sigma, we are seeking a highly skilled Patient Financial Representative Senior to join our team. This is a unique opportunity to work in a dynamic environment and contribute to the success of our organization.

Job Summary:

The Patient Financial Representative Senior will be responsible for ensuring the timely and efficient resolution of patient accounts. This includes collecting and providing patient and payor information, responding to account inquiries, and maintaining payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations.

Key Responsibilities:
  • Meet expectations of the applicable client Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
  • Perform Revenue Cycle functions in a manner that meets or exceeds clients key performance metrics.
  • Ensure PFS departmental quality and productivity standards are met.
  • Collect and provide patient and payor information to facilitate account resolution.
  • Respond to all types of account inquiries through written, verbal, or electronic correspondence.
  • Maintain payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers.
  • Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution.
  • Meet or exceed customer expectations and requirements, and gain customer trust and respect.
  • Compliant with all client, payer, and government regulations.
  • Exhibit a strong working knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
  • Appropriately document patient accounting host system or other systems utilized by PFS in accordance with policy and procedures.
  • Provide continuous updates and information to the PFS Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement, payment delays, and/or patient experience.
  • Must have professional and effective written and verbal communication.
  • Bill Review and work on claim edits.
  • Work payor rejected claims for resubmission.
  • Work reports and billing requests.
  • Demonstrate strong knowledge of standard bill forms and filing requirements.
  • Exhibit an understanding of electronic claims editing and submission capabilities.
  • Collections Collect balances due from payors ensuring proper reimbursement for all services.
  • Identify and forward proper account denial information to the designated departmental liaison.
  • Dedicated efforts to ensure a proper denial resolution and timely turnaround.
  • Maintain an active knowledge of all collection requirements by payors.
  • Work collector queue daily utilizing appropriate collection system and reports.
  • Demonstrate knowledge of standard bill forms and filing requirements.
  • Identify and resolve underpayments with the appropriate follow-up activities within payor timely guidelines.
  • Identify and resolve credit balances with the appropriate follow-up activities within payor timely guidelines.
  • Identify and communicate trends impacting account resolution.
  • Cash Reconciliation Ensures all payments are retrieved and posted accurately and timely through reconciliation of patient accounting system and bank statement.
  • Researches submitted cash payments by verifying patient account numbers and appropriate facilities.
  • Monitor and performs cash reconciliation to identify cash posting errors and ensures all receipts are applied and reconciles to daily bank deposit and monthly bank statements.
  • Review and post cash corrections, including resolving patient complaints and inquiries from PFS, Finance, Facilities, and Vendor Partners.
  • Resolve and Research unapplied cash, including continuous follow-up until payment identification is made for application of payment or refund.
Requirements:
  • Education/Skills HS Diploma or equivalent years of experience required.
  • Post HS education preferred.
  • Experience 3-5 years of experience preferred. Experience working within a multi-facility hospital business office environment preferred.
  • College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
  • Experience working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred.
  • Licenses, Registrations, or Certifications None required.

At Sigma, we offer a dynamic and supportive work environment that fosters growth and development. If you are a motivated and detail-oriented individual with a passion for patient financial services, we encourage you to apply for this exciting opportunity.