Patient Financial Services Representative/Medicare

South Shore Hospital; Weymouth (MA); On-site; USD 31,000 - 44,000; Full time

Job summary

South Shore Hospital in Weymouth, MA seeks Patient Financial Services Representatives to manage the financial aspect of patient care. You will bill, follow up on claims, and communicate with insurers to resolve denials.

Proficiency with the Epic Billing System and HIPAA compliance are essential. The role includes maintaining up-to-date billing knowledge, handling aged receivables, and collaborating with clinical and revenue-cycle teams to optimize reimbursement.

Qualifications

• Knowledge of healthcare billing, insurance plans, codes and reimbursement methods.
• Proficiency in data entry and basic computer skills.
• Excellent organizational and multitasking abilities.
• Strong interpersonal and communication skills.

Responsibilities

• Maintain up-to-date knowledge of federal, state and payer billing regulations and code sets.
• Submit UB-04 and 1500 claims; initiate corrections per payer rules.
• Navigate aged accounts receivable; contact insurers to resolve balances and denials.
• Coordinate with denials management, clinical teams and departments to resolve accounts.
• Document actions in EPIC notes; provide detailed histories for unresolved accounts.
• Identify workflow improvements and participate in process improvement initiatives.
• Use Epic, payroll and email tools to support timely and accurate billing.
• Handle 277 rejections and resubmissions; ensure proper adjustments per policy.
• Review credits for overpayments and undistributed payments.

Skills

Hospital billing

Communication skills

Regulatory knowledge

Education

High school diploma or equivalent

Tools

EPIC Billing System

Mytime payroll

MS Outlook

Sharepoint

OneDrive

Job description

Requisition Number:

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. 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.
  • 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.
• 2- 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
• 3 - 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.
• 4 - 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.
• 5 - 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.
• 6 - 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.
• 7 - 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.
• 8- Assist with identifying workflow improvements to enhance operational efficiency.
  • 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 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 indepen