Patient Financial Services Representative I

Full time (40 hours weekly)

7:00a-3:30p

Hybrid

General Summary

Completes assigned revenue cycle tasks. Assists in the completion of submitting electronic and/or manual insurance claims, resolves claim edits, performs insurance account follow-up, researches claim denials for resolution and submits disputes and appeals when necessary. Represents the System in a professional manner while interacting with peers, leaders, patients, and third-party payers to achieve timely payment on accounts in accordance with current government and payer regulations.

Duties and Responsibilities

Essential Functions:

• Corrects financial and demographic information that has been inaccurately entered into Epic.
• Performs various functions to complete and expedite the billing process including:
  • Reviews and submits Hospital and/or Physician claim forms (UB04, 1500, etc) to insurance companies via electronic or manual processes and facilitates special billing for split claims, ancillary charges, interim bills, etc.
  • Resolves Claim edits to facilitate timely billing and reimbursement.
  • Performs follow-up with insurance companies to obtain claim status, payment information and to resolve claim discrepancies.
  • Submits itemized bills, medical records, and corrected claims as needed.
  • Reviews remittance advice (835) to ensure proper reimbursement.
  • Accesses external payer sites for payer policies, claim investigations, and claim disputes.
• Reviews accounts and coordinates with appropriate departments on accounts requiring precertification, preauthorization, referral forms and other requirements related to managed care.
• Makes written and/or verbal inquiries to third party payers to reconcile patient accounts. Follows up on accounts until zero balance or turned over for collection.
• Reviews third party payer payments and investigates accounts not paid as expected. Takes appropriate corrective action to include follow up, rebilling, and/or adjustment of contractual allowances.
• Answers all inquiries regarding patient accounts.

Common Expectations:

• Maintains appropriate records, reports, and files as required.
• Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards.
• Participates in educational programs and in-service meetings.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

WellSpan Health's vision is to reimagine healthcare through the delivery of comprehensive, equitable health and wellness solutions throughout our continuum of care. As an integrated delivery system focused on leading in value-based care, we encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region's largest and one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned physicians and advanced practice providers is dedicated to providing the highest quality and safety, inspiring our patients and communities to be their healthiest.

Qualifications

Minimum Education:

• High School Diploma or GED Required

Work Experience:

• 1 year Required

Knowledge, Skills, and Abilities:

• Excellent communication and interpersonal skills
• Familiarity with payer rules and policies
• Familiarity with healthcare billing systems (Epic preferred)
• Familiarity with medical and billing terms to help interpret edit resolution, claims remittance advice, medical record documentation and payer medical/payment policies

Benefits Offered:

• Comprehensive health benefits
• Flexible spending and health savings accounts
• Retirement savings plan
• Paid time off (PTO)
• Short-term disability
• Education assistance
• Financial education and support, including DailyPay
• Wellness and Wellbeing programs
• Caregiver support via Wellthy
• Childcare referral service via Wellthy