PATIENT SERVICES REPRESENTATIVE

Sandoval Regional Medical Center; Albuquerque (NM); On-site; USD 42,000 - 54,000; Full time

Job summary

UNMH is seeking a Financial Assistance specialist to manage patient accounts receivable, reconcile claims, and coordinate with insurers to resolve denials. The role includes interviewing patients for charity programs and assisting with Medicaid eligibility, while ensuring accurate billing and coding across departments.

You will handle inquiries, research billing issues, and maintain remittance data, contributing to a smooth revenue cycle for the hospital’s Financial Assistance department.

Qualifications

• Related Education and Experience may be substituted for one another on a year for year basis.
• Education: Essential: High School or GED Equivalent

Responsibilities

• CLAIMS - Reconcile, review, research, coordinate and justify changes to claim forms and submit completed claim forms to third party payers
• CLAIMS - Reconcile and review remittances; research as necessary to determine proper accounts; research and obtain correct information; complete remittance process
• DENIALS - Follow up on claims denials; contact appropriate party to research, coordinate and justify needed information; make appropriate corrections, obtain approvals and resubmit claims denials for payments; appeal denials through the payer required appeals process
• FINANCIAL ASSISTANCE - Interview patients and complete the application process for State/Government programs; maintain MOSAA certification with the State; interview and approve patients for UNM Hospital charity and discount programs
• COLLECTIONS - Follow up on the collection of patient accounts, contact appropriate party to obtain needed information; make appropriate corrections; obtain approvals and resubmit claim for payment
• CLAIMS - Research unpaid claims; contact patients to obtain necessary information to assist with claims process; secure payments or negotiate payment plans
• CASH - Reconcile and complete cash reconciliation reports; balance and post payments, contractual allowances, and denials
• CREDIT - Research, resolve and reconcile credit balances to include processing the refund request or take back with a payer
• COORDINATION - Work with various University Hospital departments to obtain additional information regarding services rendered to include correct coding and documentation
• TRAINING - Perform training with registration and admitting personnel to assure proper registration and knowledge of business practices to include financial assistance programs
• COMMUNICATION - Handle patient inquiries, complaints and customer service issues by phone, in person or via the email; research and resolve the issue
• DATA - Perform data entry and research using various hospital system programs
• PATIENT ACCOUNTING - Maintain current knowledge of regulations for Third Party Payers, Medicare, Medicaid and knowledge of claims coding and formats
• DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops
• CUSTOMER RELATIONS - Establish and maintain good rapport and effective working relationships with patients, visitors, physicians and Hospitals employees

Education

High School or GED Equivalent

Job description

Compensation Disclaimer

Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational considerations.

Department: Financial Assistance

FTE: 1.00
Full Time
Shift: Days

Position Summary: Responsible for all patient accounts receivable functions as assigned. Reconcile, research, correct and submit third party claims and resubmit errors or denied claims. Communicate with insurance companies and government payers to resolve claim issues and ensure payment. Research and correct ICD 9, CPT coding, modifiers, revenue coding, occurrence codes and value codes as appropriate. Collaborate with the Income Support Division and the Medical Assistance Division in regards to eligibility for Medicaid. Interview and approve patients for UNMH charity programs. Provide customer service to patients by researching billing issues with various departments and resolving the issues. Reconcile remittance advices and patient accounts and resolve discrepancies. Ensure adherence to Hospital sand departmental policies and procedures. No patient care assignment.

Detailed responsibilities:

• * CLAIMS - Reconcile, review, research, coordinate and justify changes to claim forms and submit completed claim forms to third party payers
• * CLAIMS - Reconcile and review remittances; research as necessary to determine proper accounts; research and obtain correct information; complete remittance process
• * DENIALS - Follow up on claims denials; contact appropriate party to research, coordinate and justify needed information; make appropriate corrections, obtain approvals and resubmit claims denials for payments; appeal denials through the payer required appeals process
• * FINANCIAL ASSISTANCE - Interview patients and complete the application process for State/Government programs; maintain MOSAA certification with the State; interview and approve patients for UNM Hospital charity and discount programs
• * COLLECTIONS - Follow up on the collection of patient accounts, contact appropriate party (third party payers, other hospitals, patients) to obtain needed information; make appropriate corrections; obtain approvals and resubmit claim for payment
• * CLAIMS - Research unpaid claims; contact patients to obtain necessary information to assist with claims process; secure payments or negotiate payment plans
• * CASH - Reconcile and complete cash reconciliation reports; balance and post payments, contractual allowances, and denials
• * CREDIT - Research, resolve and reconcile credit balances to include processing the refund request or take back with a payer
• * COORDINATION - Work with various University Hospital departments to obtain additional information regarding services rendered to include correct coding and documentation
• * TRAINING - Perform training with registration and admitting personnel to assure proper registration and knowledge of business practices to include financial assistance programs
• * COMMUNICATION - Handle patient inquiries, complaints and customer service issues by phone, in person or via the email; research and resolve the issue
• * DATA - Perform data entry and research using various hospital system programs
• * PATIENT ACCOUNTING - Maintain current knowledge of regulations for Third Party Payers, Medicare, Medicaid and knowledge of claims coding and formats
• * DEVELOPMENT - Enhance professional growth and development through participation in educational programs, reading current literature, attending in-services, meetings and workshops
• * CUSTOMER RELATIONS - Establish and maintain good rapport and effective working relationships with patients, visitors, physicians and Hospitals employees

Qualifications

Related Education and Experience may be substituted for one another on a year for year basis.

Education:

Essential:

• * High School or GED Equivalent

Experience:

Essential:

2 years directly related experience

Nonessential:

Bilingual English, Spanish, Keres, Tewa, Tiwa, Towa, Zuni, Va\Vietnamese, or Navajo

Credentials:

Essential:

• * Not Applicable/Not Required

Physical Conditions:

Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Working conditions:

Essential:

• * No or min hazard, physical risk, office environment
• * Tuberculosis testing is completed upon hire and additionally as required