In an environment of continuous quality improvement, the Patient Financial Representative performs patient accounting related duties at the professional and primarily independent level. This position may carry out responsibilities in some or all of the following functional areas: billing, collections, credits, and customer service. Exhibits the MHS Standards of Excellence and exercises strict confidentiality at all times.
· High School Diploma, GED or equivalent required
o Patient Financial Rep II additional requirements: Minimum of 7 years of experience in billing or financial counseling and/or customer service
· Must have or be able to acquire and retain good knowledge of commercial, federal and state payer requirements
· Needs good telephone voice and skill in handling business transactions, including irate patients
· Ability to work with computerized system, also basic clerical and interpersonal skills and typing at 40 wpm
· Ability to read, understand and follow oral and written instructions
· Computer skills, including but not limited to Microsoft Word and Excel
· Excellent organizational, time management, and customer service skills
1. Follows ethical billing practices.
2. Exhibits exceptional customer service skills, utilizing AIDET.
3. Maintains compliance with patient accounting policies and procedures.
4. Completes special projects as assigned.
5. Maintains a comprehensive awareness of all insurance company updates including Federal and State guidelines.
6. Assumes all other duties and responsibilities as necessary.
1. Reviews, edits and submits claims.
2. Completes assigned daily, weekly, monthly reports.
3. Performs timely denial follow up and resubmission of claims, including correct reimbursement review until the account is resolved by either receiving payment or rejection of claim.
4. Answers inquiries from patients, guarantors, patient's families, attorneys and third party payers about billing procedures and resolves problems.
1. Conducts detailed discussions with patients and obtains information to provide to billers, Patient Financial Advocates, and all other appropriate departments to assist patients with multiple needs.
2. Uses patient information and hospital guidelines to calculate and establish payment plans.
3. If necessary, calculates patient's remaining balances, using hospital guidelines to discuss and finalize the method of resolving patient's balances through payment plans or other arrangements.
4. When necessary, calls patients with outstanding balances to review account information, examine patient's eligibility for financial assistance, secure payment arrangements or settle in full.
5. Maintains knowledge of requirements and guidelines for hospital-sponsored charity care, as well as the availability of financial assistance from external sources.
1. Prepares and submits all refund requests to the insurance companies as well as self pay refunds to patients.
2. Follow up with third party payers (Medicare, Medicaid, Blue Cross, Worker's Compensation, and Commercial Payers) until account is resolved by recoupment on an electronic remit or a check request from accounting.
3. Answers inquiries from patients, guarantors, patient's families, attorneys and third party payers about refund procedures and resolves any problems.
4. Completes assigned daily, weekly and monthly reports.