JOB SUMMARY

The Patient Financial Services Representative supports the mission of providing quality healthcare to the patients of WhidbeyHealth by performing a variety of duties that support the financial health and well-being of the organization. The PFS Representative may be responsible for coordinating patient referrals and subsequent follow up, verifying insurance and providing financial counseling to assist with self-pay accounts, as well as billing and collection of insurance and self-pay accounts. This position is expected to demonstrate professional behavior, display appropriate conduct and show consideration, respect and patience towards all patients, families, staff and professional affiliates. The PFS Representative follows all federal, state and payer specific regulations and policies pertaining to documentation and billing practices to ensure all work is in compliance with established guidelines.

PRINCIPLE FUNCTIONS includes the following, other duties may be assigned:

• Patient Referrals:

• Coordinates patients through referral and follow-up care by scheduling with appropriate specialists, facilities, agencies and insurance companies.
• Ensures that appropriate and timely follow up is provided to the patient, while documenting all patient referral information in a manner that is clear and understandable by staff.
• Requests appropriate copies of chart notes, laboratory results, radiology images, patient history and disseminates that information to the designated referral sources and monitors progress.
• Provides updates to department staff when there are changes in referral procedures, laws and insurance requirements that would affect the patients’ care plan.
• Works as an integral part of the care team, coordinating needs and patient progress with providers and other designated staff members, to ensure a cohesive and seamless referral experience for the patient and patient’s family.
• Completes all forms according to department and governmental guidelines.
• Scans all documentation into the patient’s electronic medical record.
• Maintains a comprehensive filing system that clearly identifies and updates all forms used in the referral process. Provides timely creation, updates, and corrections to forms as needed.
• May be required to provide back up to the Patient Registrar or HIM Technician on as needed basis to support department or clinic functions.
• Stays up to date on payer authorization requirements and changes.
• Submits for prior authorization when referred for internal or external exams/procedures originating within their clinic department.

• Insurance Verifier:

• Contacts insurance companies on preadmissions and admissions, verifying eligibility and benefits for patients.
• Notifies the Financial Advocate and/or service department or clinic of patients who do not have appropriate referrals and authorizations in place.
• Documents contact person name, eligibility, benefits, referrals, authorization, and any other pertinent information in notes.
• Obtains patient signatures on messages from Medicare and Tricare.
• Stays up to date on payer authorization requirements and changes.
• Acts as an insurance resource to other departments and provides training in the use of eligibility resources.
• Reviews department schedules and identifies patients not yet pre-admitted for pending services. Contacts and interviews patients by phone that have not had services within the past 90 days, obtaining demographic and insurance information.
• May be required to provide back up to the Patient Registrar or Financial Advocate on an as needed basis to support department functions.

• Financial Advocate:

• Interviews and provides financial counseling to all patients regarding patient balances.
• Arranges for the resolutions of patient liabilities through valid financial arrangements.
• Assists and advises patient in obtaining alternative financial resources in order to meet their obligation including bank loans, DSHS programs and financial assistance.
• Identifies patients for COBRA and follows through for approval.
• Obtains necessary release signatures, ensuring confidential signatures are obtained.
• Completes indicator reports on a timely basis.
• Provides price quotes when requested by patients.
• May be required provide back up to the Insurance Verifier or Patient Registrar on an as needed basis to support department functions.

• Billing and Collecting:

• Electronically and manually bills all accounts timely, to include but not limited to insurance and self-pay accounts.
• Follows up on all requests for additional information from the insurance company within established department productivity standards.
• Follows up with the insurance company to ensure payment within established department productivity standards.
• Contacts the patient or guarantor for further information to collect on the account or to resolve the account.
• Accepts payments made over the phone from patient or guarantor.
• Processes refunds to patient, guarantor, or insurance company as required.
• Promptly posts payments to accounts through DDE and electronically.
• Works closely with Third Party Payers, Collection Agencies, and Attorneys as needed.
• Understands and can articulate financial assistance policy to the patient or guarantor.
• Works through daily Queue and reports within established target levels for department productivity.
• Reviews accounts and remittance to ensure correct payment.
• Pulls insurance remits and patient payment back up for rebilling, refunds, and audits.
• Inputs statistically numbers in online reports.
• Prepares insurance appeals and follows up as required.
• Processes technical denials.
• Maintains the Itemized Statement Request Line.
• Reviews First Choice invoice and Pacific Medicaid invoice to ensure proper billing prior to sending for payment request. Identifies and resolves any errors.
• Completes financial rounding with IP/OBS patients to review patient’s financial responsibility after insurance coverage or if full self-pay.
• Provides prompt and courteous service to all visitors and callers to the Patient Financial Services department. Resolves accounts or inquiries or identifies and transfers to the appropriate party to assist further.

A PFS Representative I is eligible to move to a PFS Representative II after the completion of twelve (12) consecutive months as a PFS Representative I in their assigned department with the proven ability to perform all essential functions and competencies of the position with no recent performance improvement documentation on file.

A PFS Representative II is eligible to move to a PFS Representative III after the completion of three (3) consecutive years as a PFS Representative I-II in their assigned department with the proven ability to perform all essential functions and competencies of the position with no recent performance improvement documentation on file.

JOB KNOWLEDGE & QUALIFICATIONS

Education

High school diploma or equivalent required, advanced education preferred.

Training and Experience

One (1) year of previous related experience in a medical front office. Previous experience with billing and collections in a medical office or hospital setting strongly preferred.

Certificates, Licenses, Registrations

Certified Revenue Cycle Specialist (CRCS) certification preferred; Certified Healthcare Access Associate (CHAA) certification is acceptable for PFS Representatives working in Patient Referrals, Insurance Verifier or Financial Advocate roles.