PFS Representative I

Customer Service: In a high call volume setting, performs self-pay collections which include complex review of billing and collections activities. Resolves and researches any potential coverage to ensure timely and accurate payment. Has a complete understanding of all options to resolve the balances. Processes payments, sets up payment arrangements, and offers financial assistance to patients who are experiencing financial difficulty. Evaluates accounts and determines payment dates based on patient’s ability to pay and hospital policies. Must exhibit strong knowledge of fair debt collections. Explains charges, services, and hospital privacy regarding payment of bills. Provides technical assistance to set up MyChart access, and answers inquiries submitted through MyChart. Works assigned work queues in a timely manner.

ESSENTIAL FUNCTIONS :

• Assists management in maintaining or reducing account receivable (AR) days to meet industry standards and improve organizational cash flows.
• Ensures UB04 and HCFA 1500 claims and/or self-pay patient accounts are billed in a timely, complete, and accurate manner in accordance with appropriate guidelines.
• Provides information regarding patient accounts in response to inquiries, safeguarding confidential information in verbal replies and correspondence.
• Demonstrates understanding of the entire revenue cycle.
• Provides routine daily internal and external interface with unit/department management and staff, other service areas, information systems, physicians, physicians’ office staff, patients, software/hardware vendors, and third-party payers in order to resolve patient concerns, disputes, and billing audits in order to receive payment.
• Assists with problem solving, inquiries, and customer interaction to ensure positive results.
• Researches and analyzes any correspondence received related to assigned accounts.
• Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.
• Analyzes patient accounts, determines non-collectable accounts, and recommends bad debt or charity write-offs when applicable; analyzes and processes contractual write offs.
• Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards.
• Performs related duties as assigned.

EDUCATION: High School diploma or General Education Degree (GED) required.

EXPERIENCE: One (1) year of related experience such as medical billing or third-party collection, or customer service in a hospital, payer, or physician setting. Technical experience in CMS/Medicaid regulations and/or commercial payer billing requirements. Minimum one (1) years’ experience in a windows environment, including Excel.

LICENSURE OR CERTIFICATION : None required.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Knowledge of medical insurance practices and policies and regulations.
• Knowledge of HMO, PPO, and Indemnity third party billing guidelines (Third-Party Billing and Collections only).
• Knowledge of either UB04 hospital or CMS physician billing forms (Third-Party Billing and Collections only).
• Knowledge of government and non-government uniform billing guidelines (Third Party Billing only).
• Knowledge of medical terminology and coding Related to hospital billing and/or professional billing such as revenue, CPT diagnosis codes, modifiers, occurrence codes, value codes, and the appropriate usage of these codes.
• Skill in evaluating bills/claims for payers or patients in order to collect payment in a timely manner.
• Skill in providing assistance or training to other staff members in a team environment.
• Skill in the use of computer applications and systems including: Excel, Word, Internet, email, and miscellaneous programs and networked computer systems.
• Ability to read and comprehend instructions, short correspondence, and memos.
• Ability to write correspondence; ability to effectively present information in one-on-one and small groups situations to customers, clients, and other employees of the organization.
• Ability to read and interpret documents such as safety rules, procedure manuals, and governmental regulations.
• Ability to effectively present information and respond to inquiries or complaints from payers, patients and/or their representatives.
• Ability to demonstrate familiarity of the components of a medical chart in order to supply appropriate chart documentation to various payers as required (Third Party Billing and Collections only).
• Ability to identify any trends related to their assigned payer in order to escalate to management or provider representative (Third-Party Billing and Collection only).
• Ability to read and interpret payer explanations of benefit documents (Third-Party Billing and Collections only).
• Strong analytical and critical thinking abilities in order to make sound decisions.
• Ability to demonstrate compliance with all state and federal regulations for managed care and third party payers (Third-Party Billing and Collections only).