Patient Financial Representative

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Accurately and efficiently reviews and filesall types of claims for hospital inpatient and outpatient services to both primary and secondary payers.Analyzes accounts that have payer specific edits, timely filing limits, or need to be filed manually (paper claim), contacts payers and makes corrections needed to pass claims on for payment.

2. Review denied claims and claim lines, correct errors and submit corrected claims.  Identify trends and help complete root cause analysis to determine actions needed to prevent future denials.

3. File appeals and reconsideration requests on partial or fully denied claims; submit documentation as to obtain payment.

4. Follows up on unbilled and unpaid claims in a timely manner; pays attention to timely filing requirements in order to avoid write-offs.  Regularly works all work queues and aging reports according to standards.

5. Thoroughly documents activities on patient accounts to provide useful information to others who may view the account and avoid incorrect or duplicate activities.

6. Resolves patient inquiries, complaints, and problems regarding their accounts or refers to next appropriate level.

7. Helps cover the workload of other team members when they need assistance or are out of the office; helps cover department workload during staff shortages.