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 concerns, denials, appeals, and aged unpaid claims for commercial, government, and plan coverage.

• Relay insurance information to ancillary departments and confirm appropriate coverage using Epic, external portals, and various software applications.

• Verify patient insurance eligibility and update patient demographics, financial data, and guarantor information in Epic.

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

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

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

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

• Correct rejected claims received from claim scrubbers, clearinghouses, or payors.

• Examine explanations of payments and determine suitable actions for denial resolution, including appeals, write-offs, and patient statements.

• Investigate payor underpayments and follow up via phone on unpaid aging claims.

• Provide supporting documentation to insurance payors as needed.

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

• Attend team meetings and share insights on denial trends to enhance front-end claim edits and first-pass resolution.

• Contribute ideas for workflow improvements and best practices to optimize performance, processes, and net revenue collections.

• Offer ad-hoc support to the department during special projects, outages, or periods of high volume.

• Uphold confidentiality and adhere to HIPAA guidelines and company quality policies.

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

⛳️ 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 current understanding of government, managed care, and commercial insurance claim submission requirements, reimbursement guidelines, and coding.

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

• Knowledge of EHR operating systems and electronic health records.

• Proficient in computer systems and possess strong keyboarding skills.

• Excellent attention to detail and commitment to quality output.

• Capability to perform essential duties with or without accommodation.

• Authorization to work in the United States without sponsorship.

• Related Associate degree or medical billing certification is preferred.

• Over 4 years of experience in the medical or insurance billing field is preferred.

• Experience with Epic or other EHR applications is preferred.

• Successful completion of an Epic processes assessment with a score of 80% or higher.

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

• Ability to work at a computer and/or type for approximately 90% of a typical working day.

• Capability to work on a computer and phone simultaneously.

• Ability to use a telephone with a headset.

🏝️ Benefits

• Comprehensive health and wellness programs.

• Competitive salary and performance-based incentives.

• Opportunities for professional development and career advancement.

• Supportive work environment that fosters teamwork and collaboration.

• Flexible work schedules and remote work options.