Patient Financial Services Representative 4 – Medicaid Follow Up

This is a fully remote position, open to applicants in District of Columbia, +10 more states.

📋 Description

• Guarantees that all clean claims are submitted on the same day they are received, utilizing the correct medium and including all necessary attachments. Acts as a substitute for the supervisor or manager during their absence.

• Addresses intricate issues either through personal actions or by coordinating the information and actions of other team members, Patient Accounts staff, other hospital departments, or at the payer level. Seeks help from the supervisor when necessary.

• Ensures that claims are evaluated, corrections are identified or made, or resolutions are initiated within 24 hours of claim receipt. Identifies the need for and offers support and guidance to fellow team members to enhance their efficiency and productivity.

• Manages complex and/or high-dollar accounts while providing suitable follow-up in accordance with established protocols or SRGs.

• Ensures timely and accurate documentation of all account activities while appropriately managing all correspondence within 48 hours of receipt.

• Records activities in HealthQuest and TRAC, ensuring that documentation is professional, relevant, accurately reflects actions taken, and complies with departmental quality review standards.

• Processes payer response and rejection reports while ensuring adherence to departmental productivity and quality review standards. Maintains knowledge of payer requirements, UB-92 standards, system (Hospital, clearinghouse, payer) functionality, and hospital policies and procedures.

• Receives direction from management to address issues while also providing support, education, and guidance to team members. Performs assigned duties in the absence of the supervisor or manager.

• May undertake additional responsibilities as assigned.

⛳️ Requirements

• Education: An associate degree or an additional three years of relevant experience pertaining to the position under consideration.

• Experience: 3 years of experience in revenue cycle, finance, customer service, or data analytics.

• Experience with Medicaid Follow-Up.

• Expertise in Insurance Follow-Up Resolutions is highly preferred.

• Familiarity with payer portals.

• Proficient in hospital billing systems (e.g., Epic) and insurance verification portals.

• Knowledge of Insurance & Compliance: Extensive understanding of Medicaid, Medicare, commercial insurance, and self-pay policies. Familiarity with HIPAA regulations and hospital financial assistance programs.

• Analytical & Problem-Solving Skills: Ability to analyze patient accounts, identify discrepancies, and effectively resolve billing or insurance issues.

🏝️ Benefits

• Committed to Team Member Health: providing medical, dental, and vision coverage, along with a comprehensive team member wellness program.

• Retirement: Inova matches the first 5% of eligible contributions, starting on your first day.

• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.

• Mental Health Support: providing all Inova team members, their spouses/partners, and children with 25 mental health coaching or therapy sessions per person, per year, at no cost.

• Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules.