Financial Service Rep

Responsibilities:

• Responsible for rejections, edits, and accounts receivable for specific payer group(s) work queues as assigned.
• Initiates and coordinates follow-up activity on assigned accounts with the goal of maximizing reimbursement and ensuring timely cash flow.
• Resolves rejections related to, but not limited to, correction of registration, submission of documentation, acceptable Correct Coding Guidelines, timely filing, appeal reviews, verification of duplication claims, maximum benefits, rejections due to precertification/ authorization/referral, provider eligibility and other miscellaneous rejections.
• Demonstrates success by achieving acceptable collection rates and days in A/R for each type of insurance payer assigned.
• Demonstrates success in completing target level or above average number of accounts per week.
• Demonstrates knowledge and ability to use third party carrier computerized inquiry systems.
• Possess ability to utilize Health System professional billing and hospital patient accounting computerized systems.
• Uses worksheets from Microsoft Excel and Word.
• Initiates communication with patients and third-party insurance representatives to resolve account balances and performs appropriate action in response to the inquiry.
• Calls Insurance Companies to verify details of enrollment, benefits and coverage for in-patient, outpatient and office procedures and visits.
• Adheres to Health Systems’ write-off, discount and adjustment policies.
• Prepares reports to assess reimbursement performance.
• Maintains updated knowledge and the use of CPUP EPIC APM billing system including, BAR, Registration, PCS, Scheduling and the SMS hospital systems to view account information.
• Researches and resolves missing charges.
• Maintains knowledge and ability to use SMS for entity EPIC APM, Navinet etc.
• Provides back-up coverage OR Schedules accounting for all anesthesia records for charge entry. Picks up charges from various drop off boxes in different areas of the hospitals.
• Maintains knowledge of pre-certification to provide back-up coverage.
• Performs registrations, charge entry and payment posting as assigned.
• Maintains current knowledge of third-party carrier regulations.
• Non-essential Accountabilities:
• Maintain systems necessary for proper organization of work.
• Organizes work so that in the event of absence someone else can easily identify areas to continue and/or complete work in progress.
• Follows workload priority as assigned by the Manager on a daily basis to maximize efficiency.
• Adapts to change(s) in workflow to meet the demands of the Department.
• Demonstrates adaptability by adjusting the workflow to meet current priorities.
• Provides back-up coverage for co-workers during absences.
• Ability to access accounts via automated systems and websites, UPHS Registration, Navinet, etc.
• Reports major insurance practice changes to supervisor as they occur.

Education or Equivalent Experience:

• H.S. Diploma/GED And 3+ years' Experience in Accounts Receivable; 1 year of this experience must be in a healthcare billing environment. (Required)