Patient Financial Services Representative

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Under oversight of the Department Manager & Supervisor, the Patient Financial Services Representative – Hospital Billing will be responsible for efficient & timely billing and collections of hospital outstanding balances on inpatient and outpatient accounts receivable within assigned work queues for a large multi-facility healthcare system with future expansion anticipated to maximize reimbursement to the health system.

Job Description:

• Utilizes the Epic Hospital Billing System to review and monitor accounts through the Billing, Denial, & Follow-Up work queues

• Work assigned outstanding and denied accounts within Hospital Billing, Follow Up, & Denial work queues while maintaining established productivity requirements.

• Contacts insurance carriers or other responsible parties to confirm payment dates, question why a claim was denied or questions why a claim was not processed for payment or denial.

• Performs all Hospital Billing, Follow Up, and Denial activities necessary to obtain payment/resolution of claims.

• Reviews entire account to ensure claims were billed properly, payments were applied correctly, and all necessary adjustments were made prior to moving to next responsible party and/or adjusting balances and removing from work queue(s).

• Gathers all necessary documentation needed to have claims reprocessed/adjudicated for maximum reimbursement

• Informs and/or transfers to management of any problem accounts that require escalation within 2 days of identification

• Documents all actions taken within the EPIC account notes section and/or follow up/denial activities note sections.

• Adheres to all departmental Hospital Billing, Follow up, and Denial policies and procedures/training documents.

• Complete necessary training sessions required for the Hospital Billing system and demonstrate good working knowledge from those sessions to successfully resolve assigned accounts within Follow Up and Denial work queues

• Document all inactive periods and make them available upon management's request.

• Identifies problems in Claims Edit work queue and resubmits claims through the Epic billing system.

• Works claims edit work queue daily and resubmit claims through the Epic billing system

• Works External claim edits from Clearinghouse and resubmits claims through the Epic billing system

• Handles Paper claims processing including proper documentation

• Communicates all claims/data problems that cannot be handled to the Supervisor/Manager within one (1) day of identifying the problem.

• Identifies and researches all incomplete or inaccurate information on claims, demonstrates proper handling and escalation as needed.

• Handles payer 277 rejections of accounts and resubmits claims through Epic Billing system or other means of submission (i.e., email, fax, payer portal, certified mail) and provides trends to management for payer outreach and/or internal billing system updates to ensure timely filing and reimbursement

Education:

High School Diploma / GED Required

Licensure, Certification & Registration:

None Required 

Experience:

At least two (2) years AR/Billing experience required

Skills, Knowledge & Abilities:

Clear oral and written communication.

Professional telephone & email etiquette.

Able to interact with insurance carriers, patients, and co-workers in a professional and helpful manner.

Use of billing computer and PC skills.

Problem solving and decision making skills.

Able to work independently

Preferred Qualifications & Skills: 

Experience in Revenue Cycle Billing & Accounts Receivable

Experience working with EPIC

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment. Learn more about this requirement.

More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

Equal Opportunity Employer/Veterans/Disabled