Patient Financial Services Representative/Medicare

South Shore Health; Weymouth (MA); Hybrid; USD 31,000 - 44,000; Full time

Benefits offered by this job

Hybrid work options

Job summary

South Shore Health in Weymouth, MA seeks a Patient Financial Services Representative to manage hospital and physician billing workflows using the Epic Billing System. You will follow up on claims, resolve denials and communicate with insurers and patients to complete accurate submissions.

Hybrid or remote options may be available after training; you should have strong data entry, organization, and interpersonal skills to improve cash collections and maintain HIPAA compliance in daily patient

Qualifications

• High school diploma required; hospital or physician billing experience preferred.
• Strong data entry and organizational skills; attention to detail.
• Experience with Epic Billing System and payer communications helpful.

Responsibilities

• Maintain up-to-date knowledge of billing regulations and codes.
• Review daily claim files in work queues for UB-04 and 1500 submissions.
• Submit and resubmit claims, managedenials and appeals as needed.

Skills

Data entry

Interpersonal communication

Analytical thinking

Independent decision making

Education

High school diploma

Tools

Epic Billing System

Clearinghouse

Mytime payroll

MS Outlook

Sharepoint

OneDrive

Job description

**If you are an existing employee of South Shore Health then please apply through the internal career site.****Requisition Number:**R-24146**Facility:**LOC0014 - 549 Columbian Street549 Columbian StreetWeymouth, 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. Medicare collection and knowledge highly desired. 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**ESSENTIAL FUNCTIONS****1 - Maintains up to date knowledge of all Federal, State and Insurance specific billing regulations, policies, procedures and code sets.**a - Notifies manager of any changes that would affect claim submissionb - Protect patient privacy and confidentiality in accordance with HIPAA regulationsc- Maintain compliance with federal, state, payer, and organizational billing regulations.d- Monitor payer policy updates and communicate changes that may impact billing, collections, denials, or reimbursement processes.**2- Evaluates daily claim file using Claim Edit and Charge Review Work queues for submission of UB-04 and 1500 claim forms.**a - Initiate claim corrections as defined payer regulation and hospital policy.b - Works external claim edits from Clearinghouse and resubmits claims through EPIC**3** - **Initiate collection of aged accounts receivable through Epic work queues while prioritizing accounts based on organizational goals and aging criteria.**a - Unresolved and incomplete accounts require insurance company contact by phone, e-mail or designated web site to resolve outstanding balances.b - Collaborate with denial management staff for accounts that require clinical intervention for an appeal process.c- Collaborate with clinical departments, patient access and other departments are needed to resolve account issues.d- Generate technical appeals as needed for account resolution.e - Provide to manager a detail account history for any account that is considered uncollectable.f - 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.g - Escalates payer related issues to Provider Representative for resolution and participate in monthly meetings.h - Must maintain defined quality and productivity measures.i - Evaluate current processes, identify denial or payment trends and escalate to Management.j - Handle payer 277 rejections and resubmit through EPIC system.k - Reconcile account balances and ensure appropriate adjustments are applied according to established policies.4 - **Review credits work queues for resolution of overpayments and undistributed payments.**a - Review credit balances in assigned work queues and request refunds or payer retraction as needed.**5** - **Communicate with patients as needed for additional insurance or other information needed in order to process a claim.**a - Generate phone calls or letters as needed to obtain necessary insurance or other related information, prior to an account being placed in self pay.b - Obtain proper verification of predefined patient demographic information and maintain documentation in order to verify identity.**6** - **Embraces technological solutions to work processes and practices.**a - Uses the Mytime payroll system to enter time worked, sick days, vacations and holidays.b - Uses Epic functionalityc - Uses MS Outlook as a communication toold - Access provider web sites for verification of accounts.e - Access Sharepoint and OneDrive for stored files.**7 - Fosters a \"Culture of Safety\" through personal ownership and commitment to a safe environment.**a - Successfully answers safety questions in the annual mandatory education packet.b - Maintains a neat, organized work environment.c - Adheres to respiratory etiquette guidelines**.****8- Assist with identifying workflow improvements to enhance operational efficiency.**a- Assist leadership with special projects, audits, and process improvement initiatives.**9 - Other duties as assigned by Managements in accordance with department needs.****JOB REQUIREMENTS****Minimum Education** **-** **Preferred**High school graduate or above preferred.**Minimum Work Experience**2 years of hospital and/or physicians billing preferred**Required additional Knowledge and Abilities**Knowledge of healthcare billing, insurance plans, codes, and reimbursement methodologiesProficiency in data entry and basic computer skills, including Microsoft Office Suite.Excellent organizational and multitasking skillsStrong interpersonal and communication skillsStrong analytical and independent decision making skillsHybrid or remote work options may be availableM-F 7:00 AM - 3:30 PM. Hybrid option after training.**Responsibilities if Required:****Education if Required:****License/Registration/Certification Requirements:**