TCHP PATIENT FINANCIAL SERVICES REPRESENTATIVE

To provide support for all aspects of the Revenue Cycle billing and collections process, Responsible for the billing and collection of accounts receivable outstanding balances.  Serve as a resource for the department/services lines and other revenue cycle staff.

Act in a manner that maintains confidentiality, protects and safeguards patient personal medical and financial information at all times.

Responsible for the billing and collection of accounts receivable outstanding balances.  Provides support for all aspects of the Revenue Cycle billing and collections process, including but not limited to: Responsible for the research and resolution of all unpaid claims and the preparation of appeals for rejected or denied claims.   Responsible for the timely and accurate manual and electronic posting of patient and insurance provider payments, processing regular auditing and reconciliation reports. Review patient encounter reports to ensure accuracy and enter medical charges to initiate claim submission to ensure regulatory and compliance as well as maximum reimbursement.   Process credit balance work queues reviewing accounts for accuracy. Determines final claim status for write offs, collections or refunds.

Responsible for the timely and accurate resolution of billing and reimbursement issues, customer service and collection of outstanding balances.   Responsible for working with third party payors and intermediaries, following standard operating departmental procedures, to pursue prompt payment of professional claims for assigned financial classes, while meeting benchmarks, performance measurements and reporting requirements.

Works collaboratively with internal/external stakeholders to resolve issues pertaining to assigned workgroup.

Interacts and works with other areas of the patient financial services team to identify and resolve issues related to the billing and collections of medical claims, as well as patient and insurance provider payment posting.

May act as a resource to FSR I and preceptor to new employees.

Performs other job-related duties and assignments as requested.

KNOWLEDGE AND SKILLS:

Please describe any specialized knowledge or skills, which are REQUIRED to perform the position duties.  Do not personalize the job description, credentials, or knowledge and skills based on the current associate.  List any special education required for this position.

EDUCATION: High school diploma or equivalent required. CRCR Certification preferred.

YEARS OF EXPERIENCE:

• Minimum of 3 years recent work experience interpreting payer contracts

• Minimum of 3 years recent work experience with professional and/or hospital reimbursement and billing compliance

• Minimum of 3 years recent work experience developing and maintaining third party payer relationships

• Minimum of 3 years familiarity with Patient Financial Services (PFS) processes for claim generation and submission, billing edits, payer processing requirements, and claim / medical records audit procedures

REQUIRED SKILLS AND KNOWLEDGE:        

• Windows-based PC skills and computer proficiency required

• Advanced medical terminology, ICD-10 and CPT/HCPCS coding systems is required

• Advanced EMR/billing system (Epic preferred) knowledge required

• Advanced claims clearinghouse system knowledge required

• Advanced knowledge of payer billing requirements and claims resolution processes required

• Advanced knowledge of interpreting explanation of benefits (EOBs) and medical claim fields

• Advanced knowledge of the professional revenue cycle

LICENSES & CERTIFICATIONS :