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About the Role

The Hospital Patient Financial Services (PFS) Representative is responsible for reviewing assigned third-party and/or patient accounts, ensuring timely billing and payment from responsible payers, and documenting account/claim status and actions in the patient accounting system. This role identifies, communicates, and escalates complex claim issues and billing/payment trends, recommending solutions to leadership.

Responsibilities

Review hospital accounts assigned by system generated work-queues or reports to determine appropriate actions for moving accounts forward in the revenue cycle.
Initiate phone calls, submit website inquiries, and write letters of appeal to payers and inquiries to patients.
Recommend write offs and adjustments.
Ensure account balances are valued as per payers’ contracts.
Meet and/or exceed productivity and quality standards.
Perform root cause analyses on accounts with a solutions focus.
Track trends and escalate carrier or revenue cycle system issues to the Team Lead and/or Supervisor.
Participate in projects and audits as directed by leadership.
Collect and assemble financial documents related to billing and payment to substantiate services and reimbursement.
Collaborate with internal departments, external vendors, and IT for issue resolution and operational effectiveness.
Regularly meet with Team Lead/Supervisor to discuss and resolve billing obstacles, reimbursement issues, and process improvements.
Monitor accounts for timely filing guidelines and prioritize work accordingly.
Ensure claims are compliant, meet payer requirements, and resolve billing errors/claim rejections timely to minimize financial losses.
Escalate and report any delays in claims adjudication.
Assess payments (or lack of) and adjustments for accuracy and timeliness.
Understand and review payer reimbursement systems/contracts to establish accuracy in the A/R.
Review regulatory and contract updates to understand impacts to reimbursement from federal, state, and managed care payers.
Correct transactions and transfer balances to responsible parties as necessary.
Report and document on-going issues to management.
Promote and deliver positive patient experience and patient satisfaction.
Perform other duties as assigned.
Adhere to all organizational policies and procedures.

Requirements

A minimum of two years' experience in healthcare billing, healthcare customer service, or a related field required.
EHR experience (Epic preferred)

Skills

Competent in a variety of patient accounting systems and associated applications.
Strong knowledge of third party operations and reimbursement structures.
Knowledgeable in medical terminology, CPT, HCPCS, and ICD10 coding used in healthcare.
Ability to work independently, exercising good judgment, and multi-task in a high stress, fast-paced, and ever-changing service environment with patients, patient’s family, insurance carriers, and leadership.
Detail-oriented with solid analytical problem-solving skills.
Excellent customer service skills to communicate effectively with payers, patients, and colleagues.
Excellent communication skills including oral and written comprehension/ expression.
Ability to maintain professional conduct and good working relationships with staff, management, and payers.
Microsoft Office proficiency, subject to testing.
Ability to comply with procedural guidelines and instructions and to solicit assistance when situations arise that deviate from the usual and customary.

Location

Long Island

Work Type

Full-time

Experience Level

2+ years

Education Level

High School diploma or equivalent required.
Industry certification (AHIMA, HFMA, AAPC, etc.)

Salary/Compensations

USD $24.00 - USD $30.00 /Hr.

Benefits

Generous benefits packages
Generous tuition assistance
Defined benefit pension plan
Culture that supports professional and educational growth

About the Company

Catholic Health is one of Long Island’s finest health and human services agencies.
Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.
At Catholic Health, our primary focus is the way we treat and serve our communities.
We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.
We are committed to caring for Long Island.
Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!