Patient Financial Services Representative

South Shore Health; United States; Hybrid; USD 31,000 - 44,000; Full time

Job summary

South Shore Health is seeking a Patient Financial Services Representative in Weymouth, MA, to manage insurance claims and payment processes using the EPIC Billing System. You will submit claims, follow up on denials, and communicate with insurance companies to resolve discrepancies.

The role emphasizes accurate data entry, adherence to HIPAA, and timely, professional communication with patients and payers. Hybrid or remote work options may be available on weekdays.

Qualifications

• Knowledge of healthcare billing, insurance plans, codes, and reimbursement methodologies.
• Proficiency in data entry and basic computer skills, including Microsoft Office Suite.
• Strong organizational and multitasking skills.
• Excellent interpersonal and communication skills.
• Strong analytical and independent decision-making skills.

Responsibilities

• Keeps up-to-date knowledge of Federal, State and Insurance billing regulations and policies.
• Notifies manager of changes affecting claim submission and protects patient privacy under HIPAA.
• Monitors payer policy updates and communicates implications for billing, denials, or reimbursement.
• Evaluates daily claim files for submission of UB-04 and 1500 forms.
• Initiates claim corrections as per payer regulations and hospital policy.
• Resubmits claims through EPIC after external claim edits and pursues aged AR collections.
• Contacts insurance companies to resolve outstanding balances for unresolved/ incomplete accounts.
• Collaborates with denial management, clinical departments, and patient access to resolve issues.
• Generates technical appeals for account resolution and documents actions in EPIC notes.

Skills

Healthcare billing

Insurance plans

Coding knowledge

Data entry

Microsoft Office

Organization skills

Communication skills

Analytical thinking

Independent decisions

Education

High school diploma

Tools

Epic

Claim Edit

Charge Review

Mytime payroll

Outlook

SharePoint

OneDrive

Job description

Job Details

Requisition Number: R-23057 Facility: LOC0014 - 549 Columbian Street549 Columbian Street Weymouth, MA 02190 Department Name: SHS Patient Accounts Status: Full time Budgeted Hours: 40 Shift: Day (United States of America)

Patient Financial Services Representatives are responsible for ensuring the financial aspect of the patient’s healthcare is handled efficiently and professionally.

You will utilize the Epic Billing System to prepare, submit and follow up on compliant Hospital and Physician insurance claims to ensure payment.

Communicate with insurance companies to resolve any claim denials or discrepancies.

Compensation Pay Range: $22.20 - $31.75

Hybrid or remote work options may be available Monday through Friday 8:00am - 4:30pm

Job Responsibilities

• Maintains up to date knowledge of all Federal, State and Insurance specific billing regulations, policies, procedures and code sets.
• Notifies manager of any changes that would affect claim submission Protect patient privacy and confidentiality in accordance with HIPAA regulations Maintain compliance with federal, state, payer, and organizational billing regulations.
• Monitor payer policy updates and communicate changes that may impact billing, collections, denials, or reimbursement processes.
• Evaluates daily claim file using Claim Edit and Charge Review Work queues for submission of UB-04 and 1500 claim forms.
• Initiate claim corrections as defined payer regulation and hospital policy.
• Works external claim edits from Clearinghouse and resubmits claims through EPIC Initiate collection of aged accounts receivable through Epic work queues while prioritizing accounts based on organizational goals and aging criteria.
• Unresolved and incomplete accounts require insurance company contact by phone, e-mail or designated web site to resolve outstanding balances.
• Collaborate with denial management staff for accounts that require clinical intervention for an appeal process.
• Collaborate with clinical departments, patient access and other departments are needed to resolve account issues.
• Generate technical appeals as needed for account resolution.
• Provide to manager a detail account history for any account that is considered uncollectable.
• Document all actions taken within the EPIC account notes section and/or follow up/denial activities note section. Documentation is required at least every 30 days for all accounts requiring follow-up.
• Escalates payer related issues to Provider Representative for resolution and participate in monthly meetings.
• Must maintain defined quality and productivity measures.
• Evaluate current processes, identify denial or payment trends and elevate to Management.
• Handle payer 277 rejections and resubmit through EPIC system.
• Reconcile account balances and ensure appropriate adjustments are applied according to established policies.
• Review credits work queues for resolution of overpayments and undistributed payments.
• Review credit balances in assigned work queues and request refunds or payer retraction as needed.
• Communicate with patients as needed for additional insurance or other information needed in order to process a claim.
• Generate phone calls or letters as needed to obtain necessary insurance or other related information, prior to an account being placed in self-pay.
• Obtain proper verification of predefined patient demographic information and maintain documentation in order to verify identity.
• Embraces technological solutions to work processes and practices.
• Uses the Mytime payroll system to enter time worked, sick days, vacations and holidays.
• Uses Epic functionality.
• Uses MS Outlook as a communication tool.
• Access provider web sites for verification of accounts.
• Access SharePoint and OneDrive for stored files.
• Fosters a "Culture of Safety" through personal ownership and commitment to a safe environment. Successfully answers safety questions in the annual mandatory education packet. Maintains a neat, organized work environment. Adheres to respiratory etiquette guidelines.
• Assist with identifying workflow improvements to enhance operational efficiency.
• Assist leadership with special projects, audits, and process improvement initiatives.
• Other duties as assigned by Managements in accordance with department needs.

Job Requirements

• Minimum Education High school graduate or above preferred
• Minimum Work Experience 2 years of hospital and/or physicians billing preferred
• Required Skills, Knowledge and Abilities: Knowledge of healthcare billing, insurance plans, codes, and reimbursement methodologies
• Proficiency in data entry and basic computer skills, including Microsoft Office Suite.
• Excellent organizational and multitasking skills
• Strong interpersonal and communication skills
• Strong analytical and independent decision-making skills

Company Information

South Shore Health is a not-for-profit, charitable health system offering primary and specialty care, hospital care, home health and community care, emergency and urgent care, and preventative and wellness services. We are the largest independent health system in Southeast Massachusetts. South Shore Health brings together like-minded people who work "As One" toward a common goal of providing exceptional care the people of our region deserve. We unite top-caliber talent, technology, and service with the wishes and personal needs of patients and their families to develop individualized treatment plans.