PFS Revenue Specialist

Job Description:

VALLEY MEDICAL CENTER

Job Description

Patient Financial Services

The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.

TITLE: Patient Financial Services Revenue Specialist

JOB OVERVIEW:The PFS Revenue Specialist position is responsible for the accurate and timely review on pre-determined balance threshold assigned accounts for UB and HCFA claims. This position will manage high dollar balances as well as accounts specific to first and third party auto insurance companies for injuries sustained in a non-work related accident. The PFS Revenue Specialist will also facilitate the completion of forms by the patient (, Accident Questionnaires, Pre-Existing Condition, newborn eligibility) as requested by the payor. This includes contacting the patient by phone, drafting letters and/or site visit(s) to the patients' primary residence.

ROLE: See Administrative Partner for generic job description.

AREA OF ASSIGNMENT: Patient Financial Services

FLSA: Exempt Professional

HOURS OF WORK: As necessary to complete the job according to business needs.RESPONSIBLE TO:Manager, Patient Financial Services

PREREQUISITES:

• High school graduate or equivalent (); post high school college or training preferred.

• Three or more years' experience in health care industry required.

• Three or more years' experience in Customer Service required.

• Experience in successfully managing receivables with high dollar balances (>$20K) required. This includes follow up, billing, appeals and denial resolution.

• Experience in handling both hospital and professional claims preferred.

• Data entry skills and intermediate knowledge of Excel, Word and Outlook required.

• Experience in follow up and denial resolution of various financial classes preferred.

• Experience in Community Outreach, including visits to patient's home and/or place of business required.

• Experience filing documents with State and Federal Agencies preferred.

• Prior experience with Epic, Epremis, and Chartmaxx preferred.

Page 2 - (Patient Financial Services Revenue Specialist)

• Possess a valid driver's license and a driving record with no moving violations.

• Access to a working vehicle required for field visits.

QUALIFICATIONS:

• Excellent organizational and time management skills.

• Is flexible, adaptable, and can effectively cope with change.

• Demonstrates skills in typing and use of personal computers.

• Experience with analyzing EOB's from various insurance companies/payers.

• Excellent customer service skills. Demonstrates the ability to communicate with confidence, tact, poise, courtesy, respect, and compassion.

• Demonstrates effective communication and interpersonal skills within a diverse population.

• Demonstrates the ability to communicate effectively in English, including verbally and in writing. Effective communication includes the ability to spell accurately and write legibly.

• Practices active listening and uses a variety of questioning techniques.

• Demonstrates the ability to convey information fluently, interpreting and clarifying details and explaining rationale.

• Able to prioritize tasks, carry out assignments independently and within a team.

• Demonstrate a commitment to the organizational values by displaying a professional attitude and appropriate conduct in all situations

• Neat and well groomed in appearance.

• Regular and punctual attendance is a condition of employment.

UNIQUE PHYSICAL/MENTAL DEMANDS, ENVIRONMENT, AND WORKING CONDITIONS: See generic job description for administrative partner.

PERFORMANCE RESPONSIBILITIES

A.Generic Job Functions: See Generic Job Description for Administrative Partner

B. Unique Job Functions:

• Performs timely and accurate follow up of all high dollar outstanding balances; >$20,000 hospital, >$1,500 professional.

• Completes high dollar report and facilitates bi-weekly high dollar meeting with PFS Leadership to provide current status of outstanding balances.

• Conducts field visits for completion of patient forms as requested by the insurance payers.

• Files liens to secure funds on pending TPL claim settlements.

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• Handles workqueues related to newborn eligibility and contacts subscriber to add the patient to policy and/or provide updated insurance information.

• Researches denied claims from payers to determine steps that need to be taken for the purpose of securing payment; including but not limited to drafting appeal letters, interacting with department personnel, third party payers, attorneys and patients.

• Maintains knowledge of state and payer requirements as a fundamental business practice responsibility under Valley Medical Center's Corporate Compliance program. Reports payor changes to Manager as appropriate.

• Works collaboratively and promotes an amicable working environment developing effective working relationships with key associates (HIM, Patient Access, Hospital & Clinic Departments)

• Reviews Explanation of Benefits (EOB's) and vouchers, to pursue payment of claims.

• Responsible for ensuring accounts are reimbursed properly to include contacting the appropriate insurance company to secure and expedite payments through the follow-up and appeals resolution processes.

• Understands and adheres to all federal, state, and local payer-billing requirements.

• Contacts insurance company/ third parties, patients, physicians and/or departmental staff to obtain necessary or missing information.

• Identify, analyze and resolve payment barriers.

• Contacts payers and attorneys to collect outstanding payments.

• Demonstrated knowledge of the current functionality of patient accounting systems.

• Clearly documents activities and notes accounts as appropriate in all systems.

• Responds to requests for information, supporting documentation and other activities required to expedite and receive payment on claim.

• Responsible for editing patient insurance information on accounts in accordance with the policy and procedure.

• Communicates any content deficiencies or contracting issues to Leadership.

• Contacts insurance company/ third parties, patients, physicians and/or departmental staff to obtain necessary or missing information.

• Identify, analyze and resolve payment barriers.

• Contacts payers and attorneys to collect outstanding payments.

• Demonstrated knowledge of the current functionality of patient accounting systems.

• Clearly documents activities and notes accounts as appropriate in all systems.

• Responds to requests for information, supporting documentation and other activities required to expedite and receive payment on claim.

• Responsible to transfer account status to self-pay, request adjustments for administrative, charity care, special patient care scholarship programs when appropriate for account resolution.

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• Pulls itemized statements and Explanation of Benefits as necessary for claim submission, rebilling or appeal.

• Clearly documents activities and notes accounts as appropriate in all systems.

• Responds to requests for information, supporting documentation and other activities required to expedite and receive payment on claim.

• Faxes and / or mails account information to the insurance companies when appropriate.

• Outgoing correspondence (internal or external) must be written in a clear, concise, and professional manner.

• Informs Technical Coordinator of system issues to enhance process.

• Escalates any issues or concerns regarding individual insurance companies, including problem accounts when appropriate intervention is required.

• Returns all phone calls within 24 hours of receipt of message.

• Utilizes payer / provider instruction (online) manuals and bulletins, hospital policy / procedures, and other resource materials.

• Participate in and attend meetings and training as required.

• Cross-trains for other related business office functions to ensure smooth operation of the department. May be assigned duties across functional areas as needed.

• Maintains a consistent level of production that is within department standards.

• Facilitate proper escalation of accounts and patients' concerns when necessary.

• Documents receipt of audits and audit outcome at the account level.

• Adheres to policies, procedures and objectives as required by VMC.

• Maintains confidentiality of all protected health information.

• Performs all job functions in a manner consistent with Valley's expectations as defined in Valley Values.

• Performs other related job duties as required.
  

Created 10/15

Grade: NC03

FLSA: NE

Job Qualifications:

PREREQUISITES:

• High school graduate or equivalent (); post high school college or training preferred.

• Three or more years' experience in health care industry required.

• Three or more years' experience in Customer Service required.

• Experience in successfully managing receivables with high dollar balances (>$20K) required. This includes follow up, billing, appeals and denial resolution.

• Experience in handling both hospital and professional claims preferred.

• Data entry skills and intermediate knowledge of Excel, Word and Outlook required.

• Experience in follow up and denial resolution of various financial classes preferred.

• Experience in Community Outreach, including visits to patient's home and/or place of business required.

• Experience filing documents with State and Federal Agencies preferred.

• Prior experience with Epic, Epremis, and Chartmaxx preferred.

Page 2 - (Patient Financial Services Revenue Specialist)

• Possess a valid driver's license and a driving record with no moving violations.

• Access to a working vehicle required for field visits.

QUALIFICATIONS:

• Excellent organizational and time management skills.

• Is flexible, adaptable, and can effectively cope with change.

• Demonstrates skills in typing and use of personal computers.

• Experience with analyzing EOB's from various insurance companies/payers.

• Excellent customer service skills. Demonstrates the ability to communicate with confidence, tact, poise, courtesy, respect, and compassion.

• Demonstrates effective communication and interpersonal skills within a diverse population.

• Demonstrates the ability to communicate effectively in English, including verbally and in writing. Effective communication includes the ability to spell accurately and write legibly.

• Practices active listening and uses a variety of questioning techniques.

• Demonstrates the ability to convey information fluently, interpreting and clarifying details and explaining rationale.

• Able to prioritize tasks, carry out assignments independently and within a team.

• Demonstrate a commitment to the organizational values by displaying a professional attitude and appropriate conduct in all situations

• Neat and well groomed in appearance.

• Regular and punctual attendance is a condition of employment.