Patient Financial Service Rep

The Patient Financial Services (PFS) representative will serve as a primary support to Steward Medical Group (SMG) patients regarding any concerns related to billing, self-pay balances, insurance payments, and all other financial matters. This position will also help in collection of patient payments, setting up payment agreements and assisting in portal services.

KEY RESPONSIBILITIES:

(Use bullets for specific responsibilities)

• Provide patients with World Class service
• Act as subject matter expert and “go to” person regarding systems, policies and work flows
• Will monitor and assist to reassign some staff duties as necessary based on inbound call volumes and other work load volumes
• Monitor staff performance metrics for QA based on established standards for the department
• Answer incoming patient phone calls and make outbound collection calls on open balances
• Update patient insurance, confirming eligibility and queue claims for billing
• Update demographic and guarantor information in the Patient Accounting System
• Act in a professional manner and treat patients, co-workers, and leadership with respect at all times
• Troubleshoot and identify patient billing issues to resolve them to patient’s satisfaction
• Ability to explain and discuss SMG and PFS policies for better patient understanding
• Educate patients about third party and insurance processes, their plan benefits, and how they affect patient balances
• Evaluate accounts from both an insurance and self-pay perspective
• Evaluate accounts for self-pay refunds
• Manage and work queues and worklists in patient billing system
• Advocate for patients and contact insurance companies on their behalf, when necessary, to resolve disputes
• Assist with patients with access to the Patient Portal and password resets
• Set up payment plans, monitor and make outbound calls to patients with broken promise to pay agreements
• Ability to approach patient and discuss open, unpaid or overdue balances
• Receive and process patient credit card payments, and allocate to appropriate visits on the account
• Evaluate accounts for bad debt placement and work with bad debt vendor on patient issues and concerns
• Post appropriate discounts and adjustments to patient accounts
• Interact with supporting departments; coding, cash-ops, AR follow up to resolve billing and payment issues
• Interact with Practices to communicate and work cooperatively regarding patient billing issues
• Maintain expected performance metrics
• Other duties as assigned

REQUIRED KNOWLEDGE & SKILLS:

(Examples: Ability to work independently and take initiative; Good judgment and problem solving skills; Communication skills; Interpersonal and organizational skills; Level of confidentiality)

• Knowledge of insurance rules/regulation and policies
• Professional Working Revenue Cycle experience in either an AR follow up, Cash-Ops, denial management or self-pay role
• Ability to bring tasks to completion in a manner satisfactory to all
• Ability to communicate with others effectively in a concise manner, in order to bring issues effectively to a resolution
• Ability to identify billing trends affecting patient balances
• Ability to evaluate situations and escalate issues appropriately
• Ability to multitask, and ability to follow through with our patients and contacts
• Ability to read, understand and interpret insurance Explanation of Benefits
• Prior experience with Athena preferred
• Experience with Excel, Word and Outlook required
• Organizational, time management skills
• Ability to think globally about the patient experience

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

Education: Associates degree or relevant work experience required

Experience (Type & Length): Medical billing, preferably in a professional setting, required

Certification/Licensure: N/A

Software/Hardware: Athena and Meditech experience preferred

Other: Proven past leadership/supervisory role in a healthcare setting