Able to perform the duties for a PSR III and responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims. Able to process claims for multiple payer types (Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.). Assure all assigned claims meet clearinghouse and/or payer processing criteria. Assure appropriate follow-up on assigned work lists. All work meets departmental productivity and quality review standards. Provide Team Management with issues regarding claims follow-up process. Provide Team Supervisor or Manager with issues and potential resolutions regarding problems with the claims process. Payer response reports and rejection reports are worked timely and meet Departmental Productivity and Quality Review standards. Provide support, education, and guidance to Team. Perform duties, as assigned, in the absence of the Supervisor or Manager. Assure appropriate and timely documentation of all account activity. Correspondence is handled appropriately. WIP counts completed timely. All required reports are filed timely and accurately.
Job Summary: The Patient Financial Services Representative 4 is responsible for commercial, managed care, and government payer claim submissions in accordance with payer regulations and guidelines. The PFS Representative will facilitate the overall claim process, from resolution of claim edits and payer rejections through the submission of both electronic and paper-based institutional claims. Essential Functions: 1. Review and resolve claim edits and payer rejections to ensure accurate and timely bill submission to commercial insurance carriers. Adhere to government regulations and commercial payer billing guidelines for compliant billing. 2. Print and submit supplemental billing documentation, including but not limited to claim forms, itemized bills, and/or medical records, as needed. 3. Complete secondary and tertiary billing functions, as applicable, including submission of remittance advices or explanation of benefits forms. 4. Identify, research, and resolve unusual, complex or escalated claim issues. Notify Supervisor of developing trends and propose recommended resolution steps based on impacted payer and dollar amounts. 5. Notate all activities and findings in the billing system and in accordance with established policies and procedures to meet quality assurance and documentation standards. 6. Monitor and complete accounts assigned to PFS Representative through ownership of predetermined workqueues. Notify Supervisor of changes in volumes that may impact daily billing of claims. 7. Establish and maintain a professional and collaborative relationship with payers and Inova staff in order to resolve claim edits and payer rejections. Understand Revenue Cycle responsibilities as they pertain to billing functions and communicate with other Revenue Cycle departments to resolve billing issues. 8. Maintain knowledge of current commercial payers' billing requirements. Communicate new trends and developments to team to ensure accurate and consistent billing practices across the SBO Billing Department. 9. Meet department-specified productivity and quality standards. 10. Perform related duties as required or assigned by SBO Billing Department leadership.
Internal Number: 51262BR
About Inova Health System
Inova is a global leader in personalized health, which leverages precision medicine to predict, prevent and treat disease, enabling individuals to live longer, healthier lives. At Inova, we serve more than two million people each year from throughout the Washington, DC, metro area and beyond. Inova's mission is to improve the health of the diverse community it serves through excellence in patient care, education and research. At Inova, more than 16,000 employees demonstrate their commitment every day to providing the community with expert, world-class, compassionate patient care.