Job Summary: The Patient Financial Services Representative (PFS) is responsible for billing primary, as well as subsequent secondary and tertiary claims, to all third party insurance carriers listed on a patient account, utilizing multiple systems to ensure a clean claim is received and processed for payment. The position is also responsible for follow up on third party receivables. Position provides telephone customer service to assist patients with their insurance questions and accept payment for services billed.

Primary Job Duties:

• Claims Processing and Issues Resolution: Retrieve and transmit electronic (837) claim files to all assigned payers as assigned. Submission of a paper claim form to all assigned insurance carriers. Submit with all appropriate documents/attachments as assigned. Resolve all claim issues to ensure a clean claim has been received and accepted by assigned payer.
• Information Systems and Reporting: Effectively utilizes various assigned systems to submit and/or resolve claim issues. i.e., Omnipro, Emdeon, Navinet, Relay Health-E-Premise, Post N Track, ASK (Blue Shield), Ability/Vision share, E-PACES. Complete assigned reports from Meditech to follow up on aging receivables as assigned. DNFB-Discharged not final billed daily report as assigned.
• Claim Denials: Handle and resolve all denied claims identified through the CRANEWARE denials software system. Identify root cause analysis of denied claims as assigned.
• Third Party Payer Relationship: Problem Solve issues with third party payer as assigned. Understand the rules and regulations of third party billing for the payers assigned. Knowledge of non-governmental contract components for payers assigned. Access Third Party Carriers direct portals through the internet for issues related to obtaining eligibility verification or verification of payment of services.
• Account Follow Up: Provides follow-up by telephone/written communication on all accounts as applicable. Research and resolve all credit balances in accordance with PFS policy as assigned.
• Customer Service: Answer and respond to telephone inquiries by patients and or insurance carriers to resolve insurance and/or customer’s problems efficiently. Arrange requested payment plans with customers that call into the PFS department.

Minimum Qualifications: High school diploma or GED with at least 2 years of customer service experience. Associate's or Bachelor's degree in lieu of customer service experience. Must have proficient computer skills.