PFS Representative CBO Billing Follow-up Denials Mgt

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Our PFS Representatives are a crucial part of revenue cycle involving reducing AR and improving patient experience firsthand, post-care. As a member of the PFS Rep CBO, Billing Follow-up Denials Mgt team, you will work with the Insurance companies on behalf of the patient to assist with obtaining payments for our Acute teams and/or Ambulatory teams. In this role, you’ll bring your experience with EOBs and medical claims experience to research and hold payers accountable to pay the expected rates according to the contracts in place with Banner Health, within the allowed timeframes. Experience with different payers is a plus, along with knowledge for various denials, such as no authorization, eligibility denials, etc.

POSITION SUMMARY
This position coordinates and facilitates patient billing and collection activities in one or more assigned areas of billing, payment posting, collections, payor claims research, and other accounts receivable work. Works as a member of a team to ensure reimbursement for services in a timely and accurate manner.

CORE FUNCTIONS
1. May be assigned to process payments, adjustments, claims, correspondence, refunds, denials, financial/charity applications, and/or payment plans in an accurate and timely manner, meeting goals in work quality and productivity. Coordinates with other staff members and physician office staff as necessary ensure correct processing.

2. As assigned, reconciles, balances and pursues account balances and payments, and/or denials, working with payor remits, facility contracts, payor customer service, provider representatives, spreadsheets and the company’s collection/self-pay policies to ensure maximum reimbursement.

3. May be assigned to research payments, denials and/or accounts to determine short/over payments, contract discrepancies, incorrect financial classes, internal/external errors. Makes appeals and corrections as necessary.

4. Builds strong working relationships with assigned business units, hospital departments or provider offices. Identifies trends in payment issues and communicates with internal and external customers as appropriate to educate and correct problems. Provides assistance and excellent customer service to these internal clients.

5. Responds to incoming calls and makes outbound calls as required to resolve billing, payment and accounting issues. Provides assistance and excellent customer service to patients, patient families, providers, and other internal and external customers.

6. Works as a member of the patient financial services team to achieve goals in days and dollars of outstanding accounts. Reduces Accounts Receivable balances.

7. Uses systems to document and to provide statistical data, prepare issues list(s) and to communicate with payors accurately.

8. Works independently under general supervision, following defined standards and procedures. Reports to a Supervisor or Manger. Uses critical thinking skills to solve problems and reconcile accounts in a timely manner. External customers include all hospital patients, patient families and all third party payers. Internal customers include facility medical records and patient financial services staff, attorneys, and central services staff members.

MINIMUM QUALIFICATIONS
High school diploma/GED or equivalent working knowledge.

Requires knowledge of patient financial services, financial, collecting services or insurance industry experience processes normally acquired over one or more years of work experience. Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently. Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences.

Strong knowledge in the use of common office software, word processing, spreadsheet, and database software are required.

PREFERRED QUALIFICATIONS
Work experience with the Company’s systems and processes is preferred. Previous cash collections experience is preferred.

Additional related education and/or experience preferred.

EEO/Disabled/Veterans

Our organization supports a drug-free work environment.

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