PFS Analyst

Prisma Health; Greenville (SC); On-site; USD 40,000 - 60,000; Full time

Job summary

Prisma Health is seeking a candidate responsible for monitoring and resolving high-dollar, high-profile accounts in Greenville, South Carolina. The role demands strong healthcare revenue cycle expertise, excellent communication skills, and the ability to maintain relations with internal teams and external payers. A high school diploma and significant experience in financial services are required. The position offers a day shift in a professional environment focused on service excellence.

Qualifications

• 5 years of experience in Health Care Revenue Cycle including billing, collections, and customer service.
• CRCA or CRCR certification is preferred.

Responsibilities

• Monitors and resolves high-dollar, high-profile accounts.
• Evaluates payer performance and trends.
• Maintains professional relationships with departments and payers.

Skills

Health Care Revenue Cycle experience

Communication skills

Analytical skills

Education

High School diploma or equivalent

Job description

Job Summary

Responsible and accountable for monitoring and/or resolving high-dollar, high-profile escalated accounts, ensuring timely and accurate posting, adjustments, correspondence, and/or denials. Provides knowledge of payers and supports other team members to maintain complete, accurate, and compliant processes for optimal collection and customer service performance. Works on special projects to improve billing, accounts receivable, and denial prevention. Meets and exceeds performance and productivity standards and maintains professional relationships with all patient accounts, ancillary departments, and third-party payers in accordance with Prisma Health Service Excellence and compliance guidelines.

Accountabilities

• Monitors, researches, and resolves high-dollar, high-profile, and problem accounts, providing necessary information to internal revenue cycle departments, clinical and corporate departments, and patients for account inquiry resolution. (25%)
• Monitors, reviews, and analyzes all assigned work queues, dashboards, watch lists, payer communications, and analysis, identifying trends and working with other departments to resolve system issues. (15%)
• Demonstrates superior communication skills essential for developing and maintaining positive professional relationships across departments, payers, and industry organizations. (15%)
• Evaluates payer performance and payment trends, providing management with statistics to improve payer relations and contracting criteria, and identifies payer-specific problem trends to work with clinical departments and reimbursement teams to rectify systematic issues. (10%)
• Facilitates and participates in payer‑assigned meetings to improve payer relations, identify and resolve processing, claims, and denial issues, and ensures timely communication of meeting outcomes to PFS team members. (10%)
• Attends appropriate meetings and training seminars to stay current on billing regulations, compliance policies, industry changes, and payer reimbursement guidelines, and maintains professional growth through seminars, workshops, in‑service meetings, current literature, and professional affiliations. (5%)
• Recommends and assists in developing regular training sessions for team members to achieve high quality and productivity standards, and assists in onboarding new team members with ongoing support. (5%)
• Identifies payer-specific trends and works with revenue cycle, clinical, and corporate departments to resolve issues. (5%)
• Maintains strict adherence to department quality measures and ensures timely and accurate completion of assigned responsibilities. (5%)
• Responsible and accountable for reconciliation and accuracy of vendor invoices, vendor staff setup in EPIC, vendor collection, and expense reports. (5%)

Supervisory / Management Responsibilities

This is a non‑management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• High School diploma or equivalent
• 5 years of Health Care Revenue Cycle experience, including registration, billing, collections, credits, refunds, customer service, banking, finance, or managed care

Knowledge, Skills or Abilities

• CRCA or CRCR certification is preferred

Work Shift

Day (United States of America)

Location

Patewood Outpt Ctr/Med Offices

Facility

7001 Corporate

Department

70019012 Patient Financial Services