Patient Financial Services Representative I

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

POSITION SUMMARY:

The Patient Financial Services Representative I (PFSR I) performs foundational revenue cycle functions, including claim entry, payment posting, charge posting, and basic unpaid claim follow-up, in accordance with established policies and procedures. This role focuses on accurate data entry, timely claim submission, and consistent account review to support efficient revenue flow.

The PFSR I is responsible for identifying issues that delay claim submission or payment, including missing or inactive insurance eligibility, incomplete patient or encounter information, and system-related errors. The incumbent is expected to take appropriate action to resolve straightforward issues within scope and seek guidance on more complex situations when necessary.

This position supports skill development through hands-on experience and works collaboratively with Patient Financial Services Representative II and III staff to build proficiency in payer requirements, billing workflows, and organizational processes within a fast-paced healthcare environment. The PFSR I is expected to take ownership of assigned tasks and accounts within defined workflows, fully working items within scope and seeking guidance when necessary to ensure progress and resolution.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Work assigned accounts and tasks by applying established workflows, fully working items within scope, utilizing available resources, and seeking guidance when barriers are encountered.
• Review patient accounts to verify billing information is accurate and complete prior to claim submission.
• Enter healthcare claim data into the billing system in accordance with established procedures and payer requirements.
• Process and post payments and adjustments from third-party payers, ensuring accuracy and proper documentation.
• Independently post charges for assigned providers or service areas while maintaining accuracy and adherence to established workflows.
• Perform basic unpaid claim follow-up, including verifying claim status, identifying delays, and taking appropriate action within defined guidelines.
• Identify issues that delay claim submission or payment, including eligibility discrepancies, missing information, coordination of benefits, and system-related errors.
• Make corrections to straightforward billing issues and resubmit claims as appropriate; seek guidance on complex issues when necessary.
• Apply denials, rejections, and returns following defined workflows.
• Maintain accurate and detailed account documentation to support transparency, audit readiness, and continuity of work.
• Respond professionally to patient and payer inquiries regarding balances, explanations of benefits, copays, deductibles, and payment expectations.
• Run and review routine reports, including insurance aging, unapplied credits, and pending claims to identify accounts requiring follow-up.
• Adhere to HIPAA guidelines and organizational policies to ensure confidentiality and security of patient information.

SUPPORTING DUTIES AND RESPONSIBILITIES:

• Participate in team meetings, training sessions, and Continuous Quality Improvement (CQI) activities to strengthen billing knowledge and performance.
• Collaborate with team members as needed and seek guidance when encountering unfamiliar or complex situations.
• Assist with data cleanup, special projects, and departmental initiatives as assigned.
• Maintain a clean and orderly work area.
• Perform other job-related duties as assigned.