Patient Financial Services Representative 4 (Bilingual)

Inova Health; United States; In loco; USD 52.000 - 76.000; Tempo pieno

Descrizione del lavoro

Inova Health is seeking a Patient Financial Services Representative 4 to join our revenue cycle team. The role emphasizes timely and accurate editing, submission, and follow-up of claims across multiple payer types, with a focus on maintaining productivity and quality standards.

The position provides support and guidance to teammates and may cover supervisory duties in the absence of a manager. Team collaboration and adherence to departmental workflows are essential components of the role.

Competenze

• 3 years of experience in revenue cycle, finance, customer service or data analytics.
• Associate degree or an equivalent combination of education/experience.
• Experience with healthcare payer processes and claims workflows is preferred.

Mansioni

• Submit clean claims the day they are received with all attachments and in the correct medium.
• Resolve complex issues by coordinating information/actions with team members, other departments, or the payer level.
• Ensure reviews and corrections are identified within 24 hours of receipt and provide guidance to teammates.
• Handle complex/high-dollar accounts with appropriate follow-up per protocol.
• Document all activity in HealthQuest and TRAC within 48 hours with professional and accurate notes.
• Maintain knowledge of payer requirements, UB-92 standards, and hospital policies.

Conoscenze

Revenue cycle experience

Customer service

Data analytics

Formazione

Associate degree

Strumenti

HealthQuest

TRAC

Descrizione del lavoro

The Patient Financial Services Representative 4 performs the duties of a Patient Financial Services Representative 3 and is responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims. Processes claim for multiple payer types (i.e. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.) and ensures that all assigned claims meet clearinghouse and/or payer processing criteria. Ensures appropriate follow-up on assigned work lists while meeting all departmental productivity and quality review standards. Informs management of issues and potential resolutions regarding problems with the claims process. Provides support, education, and guidance to team members while performing duties, as assigned, in the absence of the supervisor or manager.

Job Responsibilities

• Ensures that all clean claims are submitted the day they are received, submitted via the appropriate medium, and with all required attachments. Serves in the place of the supervisor or manager in their absence.
• Resolves complex issues either through individual actions or by coordinating information/actions of other team members, Patient Accounts staff, other hospital departments, or at the payer level. Seeks assistance from supervisor when needed.
• Ensures that claims are reviewed, corrections are identified/made or resolutions are initiated within 24 hours from the date that claims are received. Identifies the need for and provides support/guidance to other team members to promote their efficiency and productivity.
• Handles complex and/or highest dollar accounts while providing appropriate follow-up based on established protocol or SRGs.
• Ensures appropriate and timely documentation of all account activity while appropriately handling all correspondence within 48 hours of receipt.
• Documents activity in HealthQuest and TRAC and ensures that documentation is professional, appropriate, accurately depicts actions performed, and is in accordance with departmental quality review standards.
• Works payer response reports and rejection reports while ensuring they meet departmental productivity and quality review standards. Maintains knowledge of payer requirements, UB-92 standards, system (Hospital, clearinghouse, payer) functionality, and hospital policies and procedures.
• Takes direction from management to resolve issues in addition to providing support, education, and guidance to team members. Performs duties, as assigned, in the absence of the supervisor or manager.
• May perform additional duties as assigned.

Additional Requirements

• Certification - Not required
• Licensure - Not required
• Experience - 3 years of Experience in revenue cycle, finance, customer service or data analytics
• Education - Associate Degree or an additional three years of experience appropriate to the position under consideration.