Patient Financial Services Associate – II

This is a fully remote position, open to applicants in United States.

📋 Description

• Accurately and promptly process claims, appeals, denials, and statements.

• Address billing discrepancies, eligibility issues, denials, appeals, and aged unpaid claims for commercial, government, and plan coverage.

• Convey insurance information to ancillary departments and ensure correct coverage using Epic, external portals, and other software.

• Review and address payor denials, appeals, and claims lacking payor response through portals, phone calls, and system investigations.

• Interpret and comprehend explanations of payments to resolve back-end claims.

• Confirm patient insurance eligibility and investigate and rectify accounts within Epic, including demographics, financial, and guarantor information.

• Engage with insurers and third-party payors to obtain and document necessary authorizations.

• Investigate missing or inaccurate account information using portals and other resources, including identifying unknown payors.

• Review and modify claims and appeals prior to clearinghouse submission.

• Analyze and resolve claim issues based on federal, state, and payor guidelines and procedures.

• Amend rejected claims from claim scrubbers, clearinghouses, or payors.

• Review explanations of payments and execute appropriate denial resolution steps, including appeals, write-offs, or statements.

• Investigate underpayments by payors and follow up on aged unpaid claims via phone.

• Provide necessary documentation to insurance payors.

• Conduct accurate and timely write-offs for uncollectible accounts.

• Participate in team meetings and share denial trends to enhance front-end claim edits and first-pass resolution.

• Offer ideas on workflow and best practices to improve performance, processes, and net revenue collections.

• Provide ad-hoc departmental support for special projects, outages, and periods of high volume.

• Uphold confidentiality and adhere to HIPAA, Quality Management System policies, and procedures.

• Fulfill responsibilities within specified timeframes and quality standards.

⛳️ Requirements

• High School Diploma or General Education Degree (GED).

• A minimum of 2 years of experience in medical billing, claims, and/or insurance processing.

• Comprehensive and up-to-date knowledge of claim submission requirements, reimbursement guidelines, and codes for government, managed care, and commercial insurances.

• Familiarity with medical terminology and/or health insurance terms.

• Understanding of EHR operating systems and experience with electronic records.

• Proficiency in computer systems and keyboarding skills.

• Demonstrated strong attention to detail and commitment to quality output.

• Ability to execute the essential duties of the position with or without accommodation.

• Authorization to work in the United States without sponsorship.

• Availability to work Monday through Friday during standard business hours.

• Capability to work in front of a computer screen and/or perform typing for about 90% of a typical working day.

• Ability to operate a computer and phone simultaneously.

• Proficiency in using a telephone with a headset.

• Successfully complete an assessment demonstrating understanding of Epic processes with a score of 80% or higher.

• Preferred: Related Associate degree or medical billing certification.

• Preferred: 4+ years of experience in the medical or insurance billing field.

• Preferred: Experience with Epic or other EHR applications.

🏝️ Benefits

• Comprehensive health and wellness benefits.

• Opportunities for professional development and growth.

• Flexible working hours to support work-life balance.

• Access to cutting-edge technology and resources.

• Collaborative and supportive work environment.