Northwest Community Hospital PFS Solutions Specialist in Arlington Heights, Illinois
Shift: Full time, Days
Reporting to the PFS Solutions Supervisor, is responsible for all interactions with patients/guarantors and third-party vendors pertaining to reimbursement and single billing office functions including transferring placement files, reconciling files and account balances, and handling customer service issues. Responsible for maximizing payment recoveries, ensuring account maintenance is completed in a timely manner while promoting vendor adherence to Northwest Community Hospital guidelines.
Serve as a point of contact for vendors and collection agencies. Sets up and implements new vendor agencies and eliminates old vendors, and uploads agency notes files into appropriate information systems. Communicates with vendors via phone, secure email, and applicable technologies and ensures vendor adherence to Northwest Community’s guidelines. Monitors no payment, no activity vendor work queues and reports recurring issues to Supervisor. Reconciles and transfers relevant files and accounts to vendors/external agencies in a timely manner and updates account status when agencies find insurance.
Provides customer and vendor support and assistance by researching, resolving, or referring customer inquiries, i.e. patients, physicians, attorneys, regarding billing and collection practices. Assumes a patient advocacy role by following through on all aspects of patient accounts. Deciphers Commercial, Government and Managed Care contracts in order to effectively communicate with patients and third party intermediaries regarding account status; expedites payment and/or brings resolution to accounts including processing of refunds and other account adjustments. Makes corrections as applicable or forwards to appropriate Claims Processing Specialists for resolution. Prepares call records for each call that requires follow up. Documents a brief summary of the call on patient’s computer record.
Performs proactive vendor account management to reduce adjustments and increase financial performance. Tracks and trends common vendor collection issues and educates users in correction of these issues.
Maintains database of statistics relative to work performed, i.e. telephone statistics, production statistics, etc.; tallies statistics on an ongoing basis. Performs analysis off of system generated Patient Accounting reports that show why patients have called. Presents statistics to management for review.
Participates in development of customer-orientated bills and professional communications; serves as a key resource by providing customer feedback regarding hospital billing/communication processes and makes recommendations for process improvement initiatives. Performs analysis of noted trends. Assists in developing plans, programs and practices to improve the efficiency, accuracy and quality of the work unit and presents recommendations to supervisor.
Meets productivity and quality targets, error ratios, and reporting requirements, as assigned by the department manager or supervisor, ensuring payments are made properly and in full per contractual agreements. Provides individual contribution to the overall team effort of achieving the department accounts receivables goal. Assists in identifying opportunities for system and process improvement and submits to management.
Utilizes assigned menus and pathways in the hospital mainframe system and foreign software applications. Report software problems when appropriate.
Supports team and fills in for staff as assigned. Drafts and submit letters and reports in accordance with departmental policy and procedure. Monitors month-end metrics, understanding baseline variances and effectively provide explanations to leadership when appropriate.
Monitors healthcare market changes as they pertain to both local and national payer trends, payment rules, and payer contracting trends.
High School Diploma or GEDrequired.
Requires a minimum ofone yearaccounting, reimbursement, finance, accounts receivable and/or credit & collection experience with knowledge of billing, payment posting, claims, remittances, insurance follow-up and reconciliation.
3.Proficientin the use of a personal computer, Excel, and Word.
Epic Billing experience preferred.
Excellent communication skills including oral comprehension/expression and written correspondence.
The ability to understand managed care contracts, federal regulation and hospital policy.
Excellent customer service skills to effectively communicate and interact daily with patients, vendors, payer sources, and guarantors. Internal contacts are made with, but not limited to, Medical Records, physicians, Nursing, Information Services, Social Services, Executive Leadership, Legal, Compliance, Utilization Review, PHO, etc.
Ability to work independently, exercising good judgment, and multi-task in a high stress, fast paced service environment with patients, patient’s family and insurance carriers.
Ability to maintain professional conduct and good working relationships with staff, supervisors, and third-party payers.
The mathematical skills necessary to balance reports and resolve discrepancies.
The ability to multi-task and effectively manage workflow through automated processes.
Detail oriented with good analytical problem-solving skills.
Requires very little physical effort. May require occasional lifting or moving lightweight material, or rarely lifting or moving average weight material.
The flow of work and character of duties involves normal mental and visual attention.
- Typical office working conditions.
Title: PFS Solutions Specialist
Location: Illinois-Arlington Heights
Requisition ID: 201629