JOB DESCRIPTION
Position Title / Job Code: PFS Representative I - III / 7640, 7650, 7660
Reports To: Department Manager
Collective Bargaining Agreement: Service and Support
FLSA: Non-Exempt
EEO Job Group: Administrative Support Workers
Effective Date:
Reviewed By: Department Manager
JOB SUMMARY
The Patient Financial Services Representative supports the mission of providing quality healthcare to the patients of WhidbeyHealth by performing a variety of duties that support the financial health and well-being of the organization. The PFS Representative may be responsible for coordinating patient referrals and subsequent follow up, verifying insurance and providing financial counseling to assist with self-pay accounts, as well as billing and collection of insurance and self-pay accounts. This position is expected to demonstrate professional behavior, display appropriate conduct and show consideration, respect and patience towards all patients, families, staff and professional affiliates. The PFS Representative follows all federal, state and payer specific regulations and policies pertaining to documentation and billing practices to ensure all work is in compliance with established guidelines.
PRINCIPLE FUNCTIONS includes the following, other duties may be assigned:
Patient Referrals:
Coordinates patients through referral and follow-up care by scheduling with appropriate specialists, facilities, agencies and insurance companies.
Ensures that appropriate and timely follow up is provided to the patient, while documenting all patient referral information in a manner that is clear and understandable by staff.
Requests appropriate copies of chart notes, laboratory results, radiology images, patient history and disseminates that information to the designated referral sources and monitors progress.
Provides updates to department staff when there are changes in referral procedures, laws and insurance requirements that would affect the patients' care plan.
Works as an integral part of the care team, coordinating needs and patient progress with providers and other designated staff members, to ensure a cohesive and seamless referral experience for the patient and patient's family.
Completes all forms according to department and governmental guidelines.
Scans all documentation into the patient's electronic medical record.
Maintains a comprehensive filing system that clearly identifies and updates all forms used in the referral process. Provides timely creation, updates, and corrections to forms as needed.
May be required to provide back up to the Patient Registrar or HIM Technician on as needed basis to support department or clinic functions.
Insurance Verifier:
Contacts insurance companies on preadmissions and admissions, verifying eligibility and benefits for patients.
Notifies the Financial Advocate and/or service department or clinic of patients who do not have appropriate referrals and authorizations in place.
Documents contact person name, eligibility, benefits, referrals, authorization, and any other pertinent information in notes.
Obtains patient signatures on messages from Medicare and Tricare.
Maintains insurance notebook on different payer requirements.
Acts as an insurance resource to other departments and provides training in the use of eligibility resources.
Reviews department schedules and identifies patients not yet pre-admitted for pending services. Contacts and interviews patients by phone that have not had services within the past 90 days, obtaining demographic and insurance information.
May be required to provide back up to the Patient Registrar or Financial Advocate on an as needed basis to support department functions.
Financial Advocate:
Interviews and provides financial counseling to all patients regarding patient balances.
Arranges for the resolutions of patient liabilities through valid financial arrangements.
Assists and advises patient in obtaining alternative financial resources in order to meet their obligation including bank loans, DSHS programs and financial assistance.
Identifies patients for COBRA and follows through for approval.
Obtains necessary release signatures, ensuring confidential signatures are obtained.
Completes indicator reports on a timely basis.
Provides price quotes when requested by patients.
May be required provide back up to the Insurance Verifier or Patient Registrar on an as needed basis to support department functions.
Billing and Collecting:
Electronically and manually bills all accounts timely, to include but not limited to insurance and self-pay accounts.
Follows up on all requests for additional information from the insurance company within established department productivity standards.
Follows up with the insurance company to ensure payment within established department productivity standards.
Contacts the patient or guarantor for further information to collect on the account or to resolve the account.
Accepts payments made over the phone from patient or guarantor.
Processes refunds to patient, guarantor, or insurance company as required.
Promptly posts payments to accounts through DDE and electronically.
Works closely with Third Party Payers, Collection Agencies, and Attorneys as needed.
Understands and can articulate financial assistance policy to the patient or guarantor.
Works through daily Queue and reports within established target levels for department productivity.
Reviews accounts and remittance to ensure correct payment.
Pulls insurance remits and patient payment back up for rebilling, refunds, and audits.
Inputs statistically numbers in online reports.
Prepares insurance appeals and follows up as required.
Processes technical denials.
Maintains the Itemized Statement Request Line.
Reviews First Choice invoice and Pacific Medicaid invoice to ensure proper billing prior to sending for payment request. Identifies and resolves any errors.
Completes financial rounding with IP/OBS patients to review patient's financial responsibility after insurance coverage or if full self-pay.
Provides prompt and courteous service to all visitors and callers to the Patient Financial Services department. Resolves accounts or inquiries or identifies and transfers to the appropriate party to assist further.
The following are expectations of all WhidbeyHealth employees:
Attends a minimum of 80% of monthly department staff meetings throughout the year. Actively participates in monthly department staff meetings, to include active participation in setting department goals and supporting department functions to meet set goals.
Checks hospital email account a minimum of three (3) times per week.
Utilizes AIDET in all interactions with patients, employees and visitors.
Completes all mandatory education within given timeframe.
Adheres to all hospital, department, and safety policies, procedures and guidelines at all times.
A PFS Representative I is eligible to move to a PFS Representative II after the completion of twelve (12) consecutive months as a PFS Representative I in their assigned department with the proven ability to perform all essential functions and competencies of the position with no recent performance improvement documentation on file.
A PFS Representative II is eligible to move to a PFS Representative III after the completion of three (3) consecutive years as a PFS Representative I-II in their assigned department with the proven ability to perform all essential functions and competencies of the position with no recent performance improvement documentation on file.
CONFIDENTIALITY
All WhidbeyHealth employees are required to maintain confidentiality in accordance with organizational policy, state and federal regulations including not but limited to the Health Insurance Portability and Accountability Act (HIPAA).
JOB KNOWLEDGE & QUALIFICATIONS
Education
High school diploma or equivalent required, advanced education preferred.
Training and Experience
One (1) year of previous related experience in a medical front office. Previous experience with billing and collections in a medical office or hospital setting strongly preferred.
Certificates, Licenses, Registrations
Certified Revenue Cycle Specialist (CRCS) certification preferred; Certified Healthcare Access Associate (CHAA) certification is acceptable for PFS Representatives working in Patient Referrals, Insurance Verifier or Financial Advocate roles.
OTHER SKILLS & ABILITIES
Knowledge of medical terminology, including terminology use in regards to insurance, inpatient and outpatient billing and coding.
Knowledge of various governmental agency and insurance requirements.
Must have the ability to be highly organized and multi-task at various work stations and settings.
Must possess effective professional interpersonal skills as well as excellent service skills in all interactions with the ability to communicate effectively on the phone, in person and in writing.
Must be able to plan, prioritize and organize work assigned within communicated deadlines.
Must demonstrate an attention to detail when completing all work assigned.
Outlined below is the level of Language Skills, Mathematical Skills, and Reasoning Ability needed to perform the essential functions of this position. Each area is evaluated and the level description included is intended to provide a summary. Please note that all skills listed may not pertain to this position.
Language Skills
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedures manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Mathematical Skills
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Reasoning Ability
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
PHYSICAL DEMANDS
The attached Work Environment & Physical Demands addendum indicates the physical demands that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORK ENVIRONMENT
The attached Work Environment & Physical Demands addendum indicates the work environment characteristics an employee encounters while performing the essential function of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
STANDARDS OF BEHAVIOR
The Standards of Behavior were developed to reflect WhidbeyHealth's commitment to excellent community healthcare. The employee's commitment to practice these Standards of Behavior will promote an optimal environment of care and foster a positive work environment. Every employee is responsible for and must follow the Standards of Behavior.
EMPLOYEE ACKNOWLEDGEMENT
I have received, reviewed and understand the job duties and responsibilities in this job description and I am able to perform the essential functions as outlined. I further understand that future performance evaluations are based on my ability to perform the duties and responsibilities outlined in this job description.
Employee Name Signature Date
The above statements are intended to describe the key aspects of the work performed by the individual(s) assigned to this position. They are not to be construed as an exhaustive listing of all requirements relative to the position. Therefore, the employee may be required to perform other duties as assigned. WBH reserves the right to modify job duties or job descriptions at any time.
PHYSICAL AND / OR MENTAL DEMANDS FOR THIS POSITION:
Check box as appropriate
Physical activities in relation to the time on the job
None or N/A
Up to 1/3
1/3 to 2/3
2/3 or More
Standing
x
Sitting
x
Walking
x
Manual dexterity (fine motor control)
x
Reach with hands and arms
x
Climb or balance
x
Stoop, kneel or crouch
x
Talk
x
Repetitive movement
x
Physical Demand
(Check box as appropriate)
Sedentary
Light
Light Medium
Medium
Heavy
Very Heavy
Lifting, Pushing, Pulling
10 lbs.
10-20 lbs.
20-40 lbs.
80-120 lbs.
Occasional (up to 1/3)
x
Frequent
x
Constant (2/3 or more)
x
Check box as appropriate
Close
Distance
Color Vision
Peripheral
Depth
Able to Focus
Vision Requirement
x
x
x
x
x
x
Check box as appropriate
Telephone
Face to Face
Close Proximity
Distant
Hearing Requirement
x
x
x
x
Mental Functioning Incidence (Check box / only as they apply)
Rarely / Never
Occasionally
Frequently
Always
Follows well defined, prescribed rules, guidelines and / or directions; exercises limited judgment
x
Simple decision making
x
Exercises some amount of decision-making affecting the work of others
x
Processes complex information and provides assessments, evaluative data and / or decisions
x
Must interact cooperatively as part of a team to complete daily assignments
x
The Work Environment & Physical Demands are intended to describe working conditions for the majority of the work performed in this position but may vary based on department needs.
Benefit Information and Wage Transparency:
WhidbeyHealth Employees who work a 0.5 FTE or higher are categorized as, "benefit eligible".
Click here for benefit information. (https://whidbeyhealth.org/wp-content/uploads/2022/12/WhidbeyHealth-Benefit-Information.pdf)
Wage Range: $21.579 - $39.710
