Department: Patient Accounting
Reports to: Revenue Cycle Supervisor
Patient Financial Services Representative
845 Jackson St, San Francisco, CA 94133
About this role
Department: Patient Accounting
Facilitate timely and accurate submission of all claims for hospital services. This includes pre-billing and/or billing of assigned accounts. Review and correct claims with errors in a timely manner. Use electronic billing methods to submit and review patient claims. Perform timely and accurate follow-up of claims for hospital services in order to maximize cash collections and minimize uncollected accounts.
Essential Duties and Responsibilities
- Review and correct all claims in error through the electronic billing system daily.
- Review the worklist daily for claims that require follow-up.
Work the 72-hour report on a daily basis.
- Maximize reimbursement and minimize billing rejections by submitting appropriate claims according to department policies and procedures while following appropriate government guidelines.
- Demonstrated effective expertise in acute care billing.
- Ability to identify and communicate billing trends impacting cash.
Request prior authorizations or retro authorizations as needed for hospital services.
- Current familiarity with the UB04 claim form, chargemaster, and compliance resources.
- Assist in the preparation of payor credit balance reporting and other audits projects as required.
- Review accounts and performs account follow-up timely and efficiently.
Resolve unbilled or unpaid claims, including rebilling of claims with late or corrected charges.
- Submit appeals and perform follow-up for daily correspondence received.
- Bill secondary commercial payors once the primary insurance has been paid correctly.
- Request Medical Records and EOB’s/RA’s as needed.
- Enter adjustments according to department Write-Off policy and procedure.
- Ability to identify and communicate trends impacting cash.
Review self-pay and self-pay after insurance accounts as assigned to ensure accurate and timely billing of patient statements.
- Review insurance refund request, verify if the refund request is valid and process accordingly.
- Maintain daily productivity reports.
- Operates with a high level of autonomy to identify trends, analyze and resolve account follow-up activities.
- Assist Patient Registration with coverage as needed to register patients or answer incoming calls.
- Accepts and performs other duties as assigned.
- High School Diploma or equivalent, with a minimum of (2) years related work experience in a hospital setting.
- Knowledge of Medicare, Medi-Cal, Managed Care, HMO, PPO, Industrial, and Third-party regulations.
- Working knowledge of basics of contracting concept, prior authorization requirements, CPT and ICD9/10 coding, the procedure for billing or adjusting late charges, duplicate charges, incorrect or incomplete codes.
- Strong communication skills; including interactions with payors, patients, physicians, and colleagues.
- Basic Keyboarding skills and computer proficiency (Microsoft Office) (EMR knowledge a plus).
- Ability to effectively present information, both verbal and written.
- Ability to take initiative, adapt to changing priorities, and work independently.
- Strong time management and prioritization skills.
- Ability to multi-task with a high level of efficiency and attention to detail.
While performing the duties of this job, staff is regularly required to sit, stand, walk, talk and/or listen. He/she uses his/her hands to do computer work, write reports, do equipment set-up/cleaning/storage, clerical support, etc. He/she will be using the phone frequently. Good vision is needed to be able to read schedules, enter accurate data, etc. He/she must have good general health and demonstrate emotional stability so as to carry out the above-enumerated duties.
- Able to lift up to 30 pounds
- Use proper body mechanics when handling equipment
- Standing, walking and moving 50% of the day
Complies with Chinese Hospital Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.