Overview
This role involves working as a Patient Accounting Representative II within the Patient Financial Services (PFS) department. The position requires accurate and timely management of accounts related to patient billing, ensuring compliance with governmental and managed care regulations. The representative will meet departmental goals, productivity, and quality standards while participating in ongoing training and education.
Responsibilities
- Review research-related charges and direct them to the appropriate financial payer source.
- Apply billing rules to research-related charges billable to third-party health insurance payers based on CMS Claims Processing guidelines for Research Services.
- Invoice study billable services to the correct study and apply standard applicable discounts.
- Assist study teams and the Clinical Trials Office (CTO) in understanding monthly invoices, answering questions, and correcting identified errors.
- Follow up with study groups on outstanding research-related billing and balances owed.
- Support traditional follow-up for claims in standard insurance billing processes related to Standard of Care services, especially when clinical trial participation impacts billing denials.
- Receive and resolve patient billing questions and complaints with compassion, courtesy, professionalism, and timeliness.
- Take actions to resolve issues such as insurance changes, claim refiling, contacting insurance companies, or answering inquiries.
- Document actions taken according to department policy.
- Collaborate closely with collection agencies to provide updated account information.
- Provide input and assist with departmental planning and process improvements.
- Communicate effectively with patients and insurance companies regarding sensitive financial matters.
- Perform professional, clinical, and/or technical competencies required by the assigned unit or department.
- Other duties as assigned.
Requirements
- High school diploma or equivalent.
- One or more years of experience in customer service, claims processing, corrections, or billing.
Preferred Qualifications
- Associate's degree in a related field from an accredited college or university.
- One or more years of experience using Epic software.
Employment Details
- Employment type: Full time
Location
Equal Opportunity and Accommodations
The employer is an equal opportunity organization that considers qualified applicants without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, ancestry, age, disability, veteran status, genetic information, or any other legally protected status. Reasonable accommodations are provided to qualified individuals with disabilities during the recruitment process upon request.
Additional Information
Employment is contingent upon agreement to the organization's dispute resolution program and signing the related agreement.