Senior Patient Financial Services Representative

Senior Patient Financial Services Representative: This 1.0FTE/Full-Time position is scheduled to work 8 HR day shifts Monday through Friday and is UFCW represented.

Compensation: Non-Exempt, $24.51/HR-$39.92/HR

Benefits:

At Mason Health, we are committed to providing our employees with a comprehensive benefits package that supports both your professional growth and personal well-being. Whether you are a Part-time or Full-time member:

Health & Wellness Benefits:

• Medical, Dental & Vision Insurance – With employer paid premiums for full-time employees

• Mental Health & Wellness Resources – Access to our Employee Assistance Program (EAP), Talkspace, and the Calm App.

• Life Insurance

• Short & Long-Term Disability Insurance

Financial Benefits:

• Retirement/Deferred Compensation Plans – Mason Health contributes 8% of your compensation every pay period when you contribute at least 5%.

• Flexible Spending Account (FSA)

• Tuition Assistance Program

• Approved by the Health Resources and Services Administration (HRSA) for student loan repayment programs.

Time Off & Work-Life Balance:

• Generous Paid Time Off (PTO) – Accrue up to 8 hours of PTO every bi-weekly pay period, starting with 5 weeks of PTO and increasing to 7+ weeks after 3 years.

Exciting Incentives:

• Sign-On and Relocation Bonuses – Only available for specific roles

• Employee Referral Program – Earn up to $7,500 depending on the role.

• Shift Differentials

Job Summary:
The Senior Patient Financial Services Representative serves as the day-to-day operational and technical lead for Patient Financial Services Representatives while performing advanced patient financial services functions. This position coordinates daily workflows and assignments, provides training and technical guidance, reviews work for accuracy and compliance, and serves as the first point of escalation for complex patient account and payer issues.
This position supports the Supervisor with departmental workflow, productivity monitoring, process improvement, staff development, and implementation of departmental procedures and changes. The Lead serves as a resource and mentor to staff but does not have formal supervisory authority, including responsibility for hiring, corrective action, or performance evaluations.

Essential Duties and Responsibilities:

1. Serves as the day-to-day lead and primary technical resource for Patient Financial Services Representatives, providing guidance on billing, collections, account resolution, financial assistance, payment posting, refunds, adjustments, and payer-related issues.
2. Coordinates and prioritizes daily work assignments and workflows to support timely completion of departmental responsibilities and established productivity and service standards. Monitors work queues, account volumes, aging, and other operational indicators and assists with redistribution of work as needed.
3. Provides training, orientation, and ongoing technical support to new and existing Patient Financial Services Representatives. Reinforces standardized processes, policies, and procedures and serves as a resource for staff questions.
4. Reviews work for accuracy, completeness, and adherence to established policies, procedures, payer requirements, and departmental standards. Provides real-time coaching and guidance to staff and escalates recurring performance or quality concerns to the Supervisor.
5. Serves as the first level of escalation for complex patient accounts, payer issues, payment discrepancies, financial assistance questions, collection matters, and other issues requiring advanced research or resolution. Escalates matters to the Supervisor or other appropriate resources when necessary.
6. Reviews, researches, and resolves complex, high-dollar, delinquent, or otherwise challenging patient accounts. Works with insurance companies, patients, guarantors, collection agencies, and other stakeholders to facilitate timely and appropriate account resolution.
7. Maintains advanced knowledge of healthcare billing, reimbursement, insurance requirements, payer contracts, patient account resolution, collections, payment posting, adjustments, refunds, financial assistance, and applicable regulatory requirements. Serves as a departmental resource regarding the application of payer and organizational requirements.
8. Reviews and updates patient demographic, insurance, and financial information and assists with complex insurance and payer payment resolution. Follows up with insurance companies on outstanding accounts and researches payment discrepancies and other account issues.
9. Processes and reviews complex adjustments, refunds, payment arrangements, financial assistance activities, and other patient account transactions in accordance with established policies and applicable requirements.
10. Posts payments and adjustments according to information received and posts miscellaneous payments to the appropriate General Ledger account as needed. Researches and facilitates resolution of payments posted to incorrect or unidentified accounts.
11. Assists patients and guarantors with complex questions regarding account balances, insurance payments, financial responsibility, payment arrangements, financial assistance, and organizational payment policies. Provides professional and appropriate service during sensitive or escalated interactions.
12. Identifies trends in denials, payment variances, account errors, collection issues, payer behavior, and workflow inefficiencies. Communicates findings to the Supervisor and assists with identifying and implementing process improvements.
13. Identifies and communicates employee performance, attendance, conduct, training, or workflow concerns to the Supervisor as appropriate. The Lead provides day-to-day direction and coaching but does not independently administer corrective action, complete formal performance evaluations, or perform other formal supervisory functions.
14. Performs the duties of a Patient Financial Services Representative as operational needs require.
15. Other duties as assigned.

Required Education and Experience: 

1. High school diploma or equivalent.
2. Minimum three (3) years of progressively responsible experience in healthcare patient financial services, medical billing, collections, reimbursement, or a closely related healthcare revenue cycle function with at least one (1) year of experience in the Mason Health Patient Financial Services department, required.
3. Demonstrated experience serving as a technical resource, trainer, mentor, or subject matter expert for other staff.

Required Knowledge, Skills and Abilities:

1. Advanced knowledge of healthcare patient financial services, including billing, reimbursement, collections, payment posting, adjustments, refunds, financial assistance, insurance requirements, and patient account resolution.
2. Knowledge of healthcare payer requirements and reimbursement practices with the ability to research, interpret, and resolve complex insurance and patient account issues.
3. Demonstrated ability to provide day-to-day work direction, technical guidance, training, coaching, and support to staff while maintaining effective working relationships.
4. Ability to coordinate and prioritize team workflows, monitor work queues and account volumes, identify operational concerns, and assist with maintaining departmental productivity and service standards.
5. Strong analytical and problem-solving skills with the ability to research complex account discrepancies, identify trends and root causes, and recommend appropriate resolutions or process improvements.
6. Ability to review the work of others for accuracy, completeness, consistency, and compliance with established policies, procedures, payer requirements, and departmental standards.
7. Professional and effective written and verbal communication skills, including the ability to communicate complex financial and insurance information clearly to patients, staff, leadership, payers, and other stakeholders.
8. Strong customer service and conflict-resolution skills with the ability to appropriately manage sensitive, complex, or escalated patient financial interactions.
9. Proficiency in electronic health records, patient accounting systems, medical billing applications, and current computer applications. Ability to learn and effectively use new systems and technology.
10. Ability to read, understand, interpret, and apply policies, procedures, payer requirements, contracts, regulatory information, and other moderately complex information.
11. Ability to organize and prioritize multiple responsibilities, meet established deadlines, adapt to changing operational needs, and work independently using sound judgment.
12. Ability to maintain confidentiality and exercise appropriate discretion when working with protected health information, patient financial information, employee matters, and other sensitive information.
13. Ability to perform mathematical calculations and analyze financial information related to patient accounts, payments, adjustments, refunds, and reimbursement.
14. Demonstrated teamwork and collaboration skills with the ability to establish and maintain effective working relationships across departments and organizational levels.

Mason Health practices equal employment opportunity towards all workforce members and applicants for employment. Mason Health does not engage in or tolerate any discrimination in the workplace prohibited by applicable local, state, or federal law. Specifically, no workforce member will be discriminated against on the basis of their race, color, sex/gender (including pregnancy), sexual orientation, religion/creed, age, disability, marital or veteran status, national origin, genetic information, or any other characteristic protected by applicable state or federal law.