Patient Financial Services Representative

Job Identification 229727

Job Category Revenue Cycle

Job Schedule Full time

Job Shift Shift1 - Day

Locations 601 Memory Ln, York, PA, 17402, US

Assignment Category Not Applicable

FTE 1

Job Description

Unit/department/service line: Patient Financial Service Rep//Claims

Status: Full Time

Schedule: Monday - Friday Dayshift

Weekend Requirement: None

Holiday Requirement: None

Call Requirement: None

General Summary

Completes assigned revenue cycle tasks. Assists in the completion of submitting electronic and/or manual insurance claims, resolves claim edits, performs insurance account follow-up, researches claim denials for resolution and submits disputes and appeals when necessary. Represents the System in a professional manner while interacting with peers, leaders, patients, and third-party payers to achieve timely payment on accounts in accordance with current government and payer regulations.

Responsibilities

Duties and Responsibilities

Essential Functions:

• Conducts timely follow-up on patient accounts billed to insurance companies to determine reasons for delayed or missing payments.

• Investigates denied or rejected claims, reviews insurance remittance advice, and identifies reasons for denial.

• Collaborates with insurance carriers, internal billing teams, and other stakeholders to obtain necessary information and documentation to resolve claims.

• Documents findings and actions taken to resolve denials or delays in payment.

• Initiates and manages appeals or resubmissions of denied claims as appropriate.

• Communicates effectively, verbally and in writing, directly with payors to follow up on outstanding claims, files technical and clinical appeals. Resolves payment delays/non-payments to ensure timely and accurate reimbursement.

• Maintains accurate records of follow-up activities and payment status in the billing system.

• Identifies trends in denied claims and recommends process improvements to reduce denials and expedite payment.

• Provides excellent customer service to patients and internal teams regarding billing inquiries and insurance follow-up.

Common Expectations:

• Maintains appropriate records, reports, and files as required.

• Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards.

• Participates in educational programs and in-service meetings.

• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Qualifications

Minimum Education:

• High School Diploma or GED Required

• Associates Degree Preferred

Work Experience:

• 1 year Required

• Prior experience in hospital billing, professional billing, or insurance follow-up/denials Preferred

Knowledge, Skills, and Abilities:

• Knowledge of insurance claims processing, payer policies, and medical terminology is essential

• Strong analytical and problem-solving skills to investigate and resolve billing discrepancies

• Excellent verbal and written communication skills for effective interaction with insurance companies and internal teams

• Proficiency with billing software and Microsoft Office Suite (Excel, Word, Outlook)

• Ability to manage multiple accounts and prioritize tasks efficiently in a fast-paced environment

• Attention to detail and commitment to accuracy

Benefits Offered:

• Comprehensive health benefits

• Retirement savings plan

• Paid time off (PTO)

• Education assistance

• Financial education and support, including DailyPay

• Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org) (https://www.joinwellspan.org/benefits/)

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.