PFS Specialist II- Patient Financial Services

Baton Rouge General Medical Center; Baton Rouge (LA); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Comprehensive benefits program

Generous paid time off

Professional development support

Flexible positions

Health and wellness programs

Job summary

A leading healthcare provider in Louisiana is seeking a detail-oriented professional for Business Office operations. This role includes analyzing outstanding account balances, processing claims within the Ambulatory Claims Manager, and resolving denials. Applicants should have a High School Diploma or GED, experience in insurance collections, and strong communication skills. The position offers a comprehensive benefits program and professional development opportunities, catering to both employee and patient needs.

Qualifications

• Experience in Business Office operations and Insurance Collections.
• Strong ability to analyze outstanding account balances.
• Experience processing claims, denials, and payment follow-up.
• Experience processing claims, denials, and payment follow-up.
• Strong documentation, organization, and communication skills.

Responsibilities

• Analyze and follow up on outstanding account balances.
• Process claims in the Ambulatory Claims Manager system.
• Resolve invalid and rejected claims within established timeframes.
• Refer delinquent responses and new denials to management as appropriate.
• Process hard copy claims for payment.
• Obtain and attach Explanation of Benefits (EOBs) for secondary and tertiary billing.
• Review claims for timely filing guidelines and fee schedule reimbursement prior to submission.
• Maintain and respond to practice communications, including RAIs.
• Monitor and escalate lack of responses when necessary.
• Assist with special projects, including reviewing 'unable to bill' claims and investigating denial reports.
• Maintain compliance with HIPAA regulations and patient confidentiality requirements.
• Follow all applicable patient and employee safety practices.

Skills

Detail-oriented

Insurance collections

Claim processing

Communication skills

Commercial insurance understanding

Follow-up

Education

High School Diploma or GED

Tools

Ambulatory Claims Manager (ACM)

Job description

Helping Patients and Practices Navigate the Financial Side of Care

What We're Looking For

• A detail-oriented professional with experience in Business Office operations and Insurance Collections
• Strong understanding of commercial insurance processes
• Ability to analyze outstanding account balances and follow up for resolution
• Experience processing claims, denials, and payment follow-up
• Strong documentation, organization, and communication skills
• High School Diploma or GED preferred

Why You'll Love Working With Us

At Baton Rouge General, our patients aren't the only people we take care of; we take care of our team too. We are proud to offer our employees the benefits and resources they need to be their best selves at work and at home.

• A comprehensive benefits program for you and your family
• Professional development and support
• Various employee perks include generous paid time off, flexible positions, and our Baton Rouge General Fit! program
• We are a nationally and locally recognized leader in quality and ranked one of the best healthcare employers in the state

Check out our employee perks: https://www.brgeneral.org/about/careers/perks

What You Will Do

Analyze and follow up on outstanding account balances while establishing acceptable payment arrangements. This role supports timely claim resolution, insurance follow-up, and denial management while maintaining compliance with organizational, regulatory, and safety standards.

Essential Job Functions Include, But Are Not Limited To

• Process claims populating into the Ambulatory Claims Manager (ACM) system
• Resolve invalid and rejected claims within established timeframes
• Document account status and actions taken within system notes
• Refer delinquent responses and new denials to management as appropriate
• Process hard copy claims for payment
• Obtain and attach Explanation of Benefits (EOBs) for secondary and tertiary billing
• Review claims for timely filing guidelines and fee schedule reimbursement prior to submission
• Maintain and respond to practice communications, including Requests for Additional Information (RAIs)
• Monitor and escalate lack of responses when necessaryAssist with special projects, including reviewing “unable to bill” claims and investigating denial reports
• Maintain compliance with HIPAA regulations and patient confidentiality requirements
• Follow all applicable patient and employee safety practices
• Perform all other duties as assigned

What Sets BRG Apart

At Baton Rouge General, we are a community of compassionate, caring individuals who set the bar when it comes to healthcare excellence. Our mission is to preserve and restore health, one person at a time. From clinical to non-clinical – what you do here matters.

With over 600 licensed beds between three campuses, Baton Rouge General offers the full spectrum of care from delivering newborns to providing end-of-life support through hospice. With clinics located throughout Baton Rouge and the surrounding areas, our physician group provides patients with comprehensive care and a full suite of specialties, including internal and family medicine and specialty care.

Ready to be part of a team that values your skills and dedication? Apply now and take the next step in your career with us.