PFS Representative CBO Billing Follow-up Denials Mgt

Banner Health Corporate; United States; Remote; USD 42,000 - 64,000; Full time

Benefits offered by this job

Remote work

Equipment provided

Job summary

Banner Health in the United States is seeking a PFS Representative to support billing and follow-up activities within the Revenue Cycle. The role is full-time and remote, with Banner providing the necessary equipment.

The ideal candidate will have 1 year of patient financial services or medical claims experience, and familiarity with EOBs, appeals, and common claim codes. This role supports both Acute and Ambulatory services and aims to optimize payments per contractual terms.

Qualifications

• Experience in patient financial services (Central Billing) or medical claims is preferred.
• Experience with submitting appeals and understanding of EOBs is preferred.
• General knowledge of codes used for claim processing.

Responsibilities

• Coordinate and facilitate patient billing and collection activities in billing, payment posting, collections, payor claims research and other accounts receivable work.
• Reconcile accounts, pursue balances, and work with payors, contracts and payor customer service to maximize reimbursement.
• Research payments and denials, determine short/over payments, and make appeals and corrections as needed.
• Build strong relationships with internal clients and provide excellent customer service to patients, families, providers, and external customers.
• Respond to calls and make outbound calls to resolve billing, payment and accounting issues.

Skills

Patient financial services

EOB appeals

Denials knowledge

Education

High school diploma/GED

Job description

Department Name: Amb Billing & Follow Up

Work Shift: Day

Job Category: Revenue Cycle

Innovation and highly trained staff. Banner Health recently earned Great Place To Work® Certification™. This recognition reflects our investment in workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of our team members. Find out how we're constantly improving to make Banner Health the best place to work and receive care.

Our PFS Representatives are a crucial part of revenue cycle involving reducing AR and improving patient experience firsthand, post-care. As a member of the PFS Rep CBO, Billing Follow-up Denials Mgt team, you will work with the Insurance companies on behalf of the patient to assist with obtaining payments for our Acute teams and/or Ambulatory teams. In this role, you'll bring your experience with EOBs and medical claims experience to research and hold payers accountable to pay the expected rates according to the contracts in place with Banner Health, within the allowed timeframes. Experience with different payers is a plus, along with knowledge for various denials, such as no authorization, eligibility denials, etc.

Schedule : Full time, Monday-Friday, 8hr shifts, typically 8am-5pm (depending on team)

Location : REMOTE, Banner provides equipment

Ideal candidate :

• 1 year patient financial services (Central Billing) or medical claims experience (clearly reflected in attached resume)
• Experience with submitting appeals and understanding of EOB
• General knowledge of codes used for claim processing

This can be a remote position if you live in the following state(s) only: AL, AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, LA, MD, MI, MN, MO, MS, NC, ND, NE, NH, NY, NM, NV, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI, WV, WY

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.

POSITION SUMMARY

This position coordinates and facilitates patient billing and collection activities in one or more assigned areas of billing, payment posting, collections, payor claims research, and other accounts receivable work. Works as a member of a team to ensure reimbursement for services in a timely and accurate manner.

CORE FUNCTIONS

• May be assigned to process payments, adjustments, claims, correspondence, refunds, denials, financial/charity applications, and/or payment plans in an accurate and timely manner, meeting goals in work quality and productivity. Coordinates with other staff members and physician office staff as necessary ensure correct processing.
• As assigned, reconciles, balances and pursues account balances and payments, and/or denials, working with payor remits, facility contracts, payor customer service, provider representatives, spreadsheets and the company's collection/self-pay policies to ensure maximum reimbursement.
• May be assigned to research payments, denials and/or accounts to determine short/over payments, contract discrepancies, incorrect financial classes, internal/external errors. Makes appeals and corrections as necessary.
• Builds strong working relationships with assigned business units, hospital departments or provider offices. Identifies trends in payment issues and communicates with internal and external customers as appropriate to educate and correct problems. Provides assistance and excellent customer service to these internal clients.
• Responds to incoming calls and makes outbound calls as required to resolve billing, payment and accounting issues. Provides assistance and excellent customer service to patients, patient families, providers, and other internal and external customers.
• Works as a member of the patient financial services team to achieve goals in days and dollars of outstanding accounts. Reduces Accounts Receivable balances.
• Uses systems to document and to provide statistical data, prepare issues list(s) and to communicate with payors accurately.
• Works independently under general supervision, following defined standards and procedures. Reports to a Supervisor or Manger. Uses critical thinking skills to solve problems and reconcile accounts in a timely manner. External customers include all hospital patients, patient families and all third party payers. Internal customers include facility medical records and patient financial services staff, attorneys, and central services staff members.

MINIMUM QUALIFICATIONS

High school diploma/GED or equivalent working knowledge.

Requires knowledge of patient financial services, financial, collecting services or insurance industry experience processes normally acquired over one or more years of wor