Patient Financial Services Associate II

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

📋 Description

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

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

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

• Examine and resolve payor denials, appeals, and claims with no responses via portals, payor calls, and system investigations.

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

• Assess patient insurance eligibility, investigate accounts, and correct patient demographics, financial data, and guarantor information in Epic.

• Engage with insurers and third-party payors to procure and document authorization.

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

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

• Analyze, research, and resolve claim issues in accordance with federal, state, and payor rules and procedures.

• Rectify rejected claims from the claim scrubber, clearinghouse, or payor.

• Assess explanations of payments and execute next steps for denials, including appeals, write-offs, or patient statements.

• Investigate payor underpayments and follow up with payors by phone regarding unpaid aging claims.

• Provide necessary supporting documentation as requested by insurance payors.

• Conduct accurate and timely write-offs for uncollectible accounts in line with policies and guidelines.

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

• Contribute workflow and best-practice suggestions to enhance performance, processes, and net revenue collections.

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

• Fulfill responsibilities within required timelines while adhering to quality standards.

• Stay updated on medical billing regulations, rules, and guidelines.

• Maintain confidentiality and comply with HIPAA guidelines and regulations.

• Uphold the company's Quality Management System policies and procedures.

⛳️ Requirements

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

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

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

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

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

• Proficient in computer systems and possess strong keyboarding skills.

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

• Demonstrated ability to perform the Essential Duties of the position with or without accommodation.

• Authorization to work in the United States without sponsorship.

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

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

• Capability to work in front of a computer screen and/or type for approximately 90% of a typical workday.

• Ability to operate a computer and phone concurrently.

• Ability to utilize a telephone through a headset.

• 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

• Reasonable accommodations are available, if necessary, to assist an employee with a disability.

• Equal Opportunity Employer of Minorities/Women/Individuals with Disabilities/Protected Veterans.