Patient Financial Services Representative II - #304065

*Candidates from Alaska, Washington, Oregon and Texas are encouraged to apply*

POSITION SUMMARY:

The Patient Financial Services Representative II (PFSR II) independently manages patient accounts and performs intermediate to advanced revenue cycle functions, including claim correction, denial resolution, appeals, payment posting, charge auditing, and unpaid claim follow-up. This role focuses on resolving accounts, ensuring accuracy, and supporting optimal reimbursement in accordance with established policies and payer requirements.

The PFSR II applies knowledge of coding, coordination of benefits, payer sequencing, and reimbursement guidelines to identify, research, and resolve issues that delay claim submission or payment. Responsibilities include analyzing denials, correcting claim errors, and submitting appeals as appropriate.

The PFSR II is expected to work assigned accounts independently to resolution using available resources, critical thinking, and payer knowledge, collaborating on complex or non-routine issues when necessary. This role provides guidance and shares knowledge with team members as needed during daily operations, without supervisory responsibility.

In addition, the PFSR II recognizes patterns in denials and reimbursement issues, contributing to process improvement discussions and supporting efforts to reduce recurring errors.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Work assigned accounts and tasks by applying established workflows, fully working items independently to resolution using available resources and seeking collaboration when necessary for complex or non-routine issues.
• Independently review and manage patient accounts across multiple service areas to ensure accurate billing, payment application, and follow-up.
• Identify, research, and resolve denied and unpaid claims, including correcting claim errors and submitting appeals in a timely manner.
• Analyze payer responses, explanation of benefits (EOBs), and remittance advice to determine appropriate next steps.
• Submit corrected claims and appeals with appropriate documentation to support reimbursement.
• Audit charges, payments, and adjustments to ensure accuracy and compliance with billing standards.
• Post payments, adjustments, and denials accurately while maintaining clear and complete account documentation.
• Perform unpaid claim follow-up, including contacting payers, verifying claim status, and resolving delays.
• Identify trends or recurring issues impacting reimbursement, communicate findings, and contribute to solutions aimed at reducing future occurrences.
• Participate in identifying opportunities to improve billing workflows, claim accuracy, and denial prevention.
• Run, review, and analyze routine and ad hoc reports, including insurance aging, claim holds, unapplied credits, and work-in-progress accounts.
• Ensure compliance with payer guidelines, contractual requirements, and billing regulations.
• Respond to patient and payer inquiries regarding account status, billing details, and financial responsibility.
• Adhere to HIPAA guidelines and organizational policies to ensure confidentiality and security of patient information.

SUPPORTING DUTIES AND RESPONSIBILITIES:

• Provide guidance and share knowledge with PFSR I staff during daily operations.
• Collaborate with team members and other departments to resolve account issues and improve workflows.
• Participate in team meetings, training sessions, and Continuous Quality Improvement (CQI) initiatives.
• Assist with special projects, reporting needs, and data cleanup efforts as assigned.
• Maintain a clean and orderly work area.
• Perform other job-related duties as assigned.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

Work Experience: Three to five years of experience in medical billing, patient financial services, or revenue cycle operations, or demonstrated competency in independently managing accounts, resolving denials, and navigating payer requirements.

Education, Certification and Licensure: High school diploma or equivalent required. Medical billing training preferred. Certifications such as CPC, CBC, or other AAPC credentials are preferred but not required

Additional Skills & Knowledge:

• Working knowledge of ICD-10, CPT, HCPCS, NDC, and CDT coding structures and payer-specific billing requirements.
• Strong understanding of coordination of benefits, payer sequencing, and denial management.
• Ability to analyze account activity and resolve discrepancies independently.
• Proficiency in billing systems, Microsoft Office, and ten-key data entry.
• Strong attention to detail, time management, and organizational skills.
• Effective communication and customer service skills.