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8110 Gatehouse Road, Falls Church, VA 22042

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Patient Financial Service Representative 3

System Offices - Telestar 601750 Full Time 2990 Telestart Court, Falls Church, VA, 22042, US
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Job Description

Able to perform the duties of a PSR II and responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims. Able to process claims for at least two payer types (Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.). Assure all assigned claims meet clearinghouse and/or payer processing criteria. Assure appropriate follow-up on assigned work lists. All work meets departmental productivity and quality review standards. Provide Team Management with issues regarding claims follow-up process. Payer response reports and rejection reports are worked timely and meet Departmental Productivity and Quality Review standards. Assure appropriate and timely documentation of all account activity. Correspondence is handled appropriately. WIP counts completed timely. All required reports are filed timely and accurately.

Job Responsibilities
 
  • Able to perform the duties of a PSR II and responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims. Able to process claims for at least two payer types (Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.). Assure all assigned claims meet clearinghouse and/or payer processing criteria. Assure appropriate follow-up on assigned work lists. All work meets departmental productivity and quality review standards. Provide Team Management with issues regarding claims follow-up process.
    • All clean claims should be submitted the day they are received and submitted via the appropriate medium (paper vs. electronic) and with all required attachments. Claims are reviewed, corrections identified, and corrections made, or resolution initiated within 24 hours of the date the claim was received.
    • Provide resolution for pended (WIP backlog) claims within allowable timeframes (as defined for appropriate deficiency) and/or provides appropriate account follow-up based on established protocol or SRGs - able to resolve basic issues either through individual actions or by seeking assistance and direction from Team Management.
    • Productivity and quality expectations met weekly for assigned work lists and any Supervisor assigned special tasks.
    • Write-off requests are completed correctly and submitted daily for Supervisor review.
    • Document and report claims submission issues immediately and provide feedback to Team management regarding the issues and wins.
  • Payer response reports and rejection reports are worked timely and meet Departmental Productivity and Quality Review standards.
    • Payer response/rejection reports are worked daily. All issues are resolved, or resolutions initiated within 24 hours.
    • Identify issues with payer rejections, provide feedback regarding rejections to Team Management. Take direction from Supervisor or Manager to resolve issues.
    • Maintain knowledge of payer requirements, UB-04 standards, and system (Hospital, clearinghouse, payer) functionality, and Hospital policy and procedure.
  • Assure appropriate and timely documentation of all account activity. Correspondence is handled appropriately.
    • Document activity in HealthQuest and TRAC as appropriate.
    • Assure documentation is professional, appropriate, and accurately depicts actions performed and is in accordance with Departmental Quality Review Standards.
    • All correspondence is handled appropriately and with 48 hours of receipt or within the customer's expectations.
  • WIP counts completed timely. All required reports are filed timely and accurately.
    • Weekly WIP counts completed timely.
    • All daily, weekly, and monthly reports are completed and submitted timely and reports are completed with minimal errors.


Additional Requirements

Experience:

  • Two years of experience in healthcare revenue cycle, finance, customer service, or data analytics
     

Education:

 

Special Skills:

  • Knowledge of Microsoft Office products (Word, Excel, PowerPoint, Access) or equivalent software.
  • Ability to think critically and resolve accounts with minimal supervision.
  • Working knowledge of patient accounting systems, such as Epic.