Job title

Patient Financial Services Representative 

Reports to

Controller

FLSA Status

Non-Exempt

Position Summary

The Patient Financial Services Representative performs a variety of routine and non-routine clerical/patient accounting functions in accordance with standard procedures in one or more of the following areas: patient accounting, accounts receivable, or hospital revenue cycle for the Cherry County Hospital and Clinic. 

Duties and Responsibilities

Regular responsibilities include but are not limited to the following:

• Works daily electronic billing file and submits insurance claims to third-party payers
• This position is responsible for posting monies received from all payor types (including Medicare, Medicaid, Managed Care, HMO, PPO, and patient)
• Accurate billing of patient accounts, ensuring timely claim submission and reimbursement from various third- party payers and patients, ensuring proper account documentation in the facility's billing system, and pursuing follow-up efforts on aged accounts 
• Reviews, evaluates, and forwards manual patient account statements to payers that do not accept electronic claims or that require special handling
• Documents billing activity on the patient account; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to CFO
• Reviews claims for accuracy and coordinates with ancillary departments as needed to provide information for audits and/or record reviews
• Based on electronic payers' error reports, makes appropriate corrections to optimize the electronic claims submission process
• Ensures payments and adjustments are accurately posted to patient accounts 
• Reviews claims for accuracy and coordinates with ancillary departments as needed to provide information for audits and/or record reviews
• Based on electronic payers' error reports, makes appropriate corrections to optimize the electronic claims submission process
• Ensures payments and adjustments are accurately posted to patient accounts 
• Ensures payments in correct computer log to assure accurate patient statements
• Responds to written/oral requests for itemized bill from any customer including patient, insurance company, and attorney
• Researches all patient and insurance refunds in accordance to best practice/benchmark for compliance
• Calls patients to collect on outstanding balances, collecting insurance information, or providing payment options
• Responds to patients inquiries regarding the status of insurance claims or balances due
• Visits patients in the Emergency Department or the hospital to obtain information for billing or provider Medicaid application
• Review outstanding patient balances prior to patients receiving elective services to secure appropriate payment arrangements and/or compliance with previously established payment arrangements
• Ensures timely resolution of credits by accurate and timely refunds to the appropriate entity(s) and patient(s), prepares daily deposit and control sheets
• Sorts the mail and is responsible for distribution to the appropriate area/person
• Obtains pre-authorizations for services/procedures when required by the patient’s payor
• Posts charges onto the patient account for supplies and services that were provided to the patient to ensure proper billing and reimbursement
• Various other reporting and miscellaneous reports relating to Revenue Cycle functionality, Accounts Payable or Timekeeping could be required
• Ensures the confidentiality of patients’ medical, personal, and financial records is maintained
• Knowledgeable of and committed to practicing Corporate Compliance policies and procedures
• Complies with Cherry County Hospital personnel policies
• Performs other duties as assigned by the supervisor

Skills and Abilities Required

• Ability to type, operate business machines including computers, and complex telephone systems
• Verbally interact with a variety of individuals
• Read fine print on documents
• Access files in order or execute the proper handling of accounts receivable credit and collection
• Execute general office duties as necessary in a proper manner
• Ability to interact with utmost courtesy and tact
• Supremely capable of projecting a demeanor of warmth and welcome to any and all individuals who presents themselves to the business office
• Ability to maintain confidentiality of any and all hospital and patient affairs
• Ability to read, write, verify, utilize, understand, trace, tender, tabulate, systemize, submit, study, organize, sort, search, scan, process, post, participate, move, locate, investigate, formulate, examine, draft, correspond, decide, classify, and/or assemble business office materials, instruction and equipment
• Ability to sit, stand, and walk variable distances
• Must be knowledgeable of state and federal confidentiality laws, including but not limited to HIPAA, and be familiar with and follow all policies, procedures and instructions regarding the privacy and security of protected health information applicable to the position

Physical Demands and Working Conditions

• Works in a well-lighted and ventilated office
• Subject to frequent interruptions
• Normal office environment with little exposure to excessive noise, dust, temperature, and the like
• Characterized as work requiring exertion of negligible up to 50 pounds of force periodically by moving objects
• Requires sitting, talking, repetitive motion, and listening to a significant degree
• Requires significant manual dexterity to operate business office machines and equip and to meet job performance standards and criteria
• Requires verbal ability to communicate via telephone and typical voice interaction 
• Requires auditory ability sufficient to hear telephone with typical hearing impaired enhancements and to hear normal conversation typical or an office setting

Direct reports

This position has no direct reports.

 Minimum Job Requirements

• High School diploma required
• 1 to 3 years of customer service and/or business office experience, ideally in a medical setting preferred
• Prior experience and knowledge in the use of software packages such as Microsoft Excel, Word, and Windows
• Knowledge of collection laws, 3rd party reimbursement, and basic hospital accounting