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Senior PFS Representative / Patient Financial Services / Full Time / Kearny Mesa

Company: Careerbuilder-US
Location: Orange
Posted on: November 26, 2022

Job Description:

HoursShift Start Time:VariableShift End Time:VariableAdditional Shift Information:Flex hours starting 7-9 amWeekend Requirements:As NeededOn-Call Required:No
What You Will DoUnder the supervision of the Manager/ Team Lead, responsible for escalating AR trends and Payer contractual issues to Management. Generates various billing related reports and review issues with Team Lead and/or Management to expedite decision making on handling the AR. Provides support to Team lead, through on the job training to AR Analysts, answering their payer and billing related questions and providing help as needed, to ensure the accurate and timely performance of departments day-to-day functions. Proactively follow up with payer contacts and Sharp contracts Team to ensure necessary information is obtained in order to resolve issues for timely collections of accounts receivables.Required Qualifications

  • H.S. Diploma or Equivalent
  • 3 Years revenue Cycle experience in a health care system.
  • Experience with charge posting accurately in compliance with payer documentation standards for PPO, Occupational Medicine, Medicare, Medi-cal, HMO and third party payer requirements for professional fee billing.
  • Experience managing a variety of projects with successful outcomes.
  • Experience in accounts receivable management of multiple payers: HMO, PPO, Workers Compensation, and non-contracted insurance handling.
  • Cash posting experience and receivables management of multiple payers.
  • Experience in collection efforts on outstanding accounts includes but is not limited to: telephone contact with patients and payers, working of collection reports both insurance related and self-pay accounts, correspondence (both self-pay and insurance related), auditing accounts for posting accuracy, appeals, reviews of denied claims as necessary and be able to identify and report on denial trends by carrier.Essential Functions
    • Account managementMonitors daily reports for edits/rejections to identify trends or error patterns. All edits worked within the timeframe set up of the software dates.Ensure paper claim are processed accurately with appropriate supporting documentation to minimize adjustments due to incorrectly submitted claims.Follow up with insurance companies on more difficult accounts for trending and analysis with Team Lead and to help problem solve.Through personal productivity and working with team, contributes to the department A/R goals of net A/R days at or below set goal for the FY. Greater than 90 days percent of A/R at or below for the set goals of the current FY. Greater than a year days percent at or below for goals set for the current FY.Self-Pay A/R Management.Cash posting A/R Management.Underpayments AR management.
    • CommunicationReport user training and education needs to Lead and management.Regularly communicate with payers on AR issues that are escalated using the "Payer Issue Escalation" process.
    • Problem analysis and resolutionPerforms thorough problem analyses using sound judgment and shares with initiative and own discretion.Collaborate and coordinate issue resolutions with department managers, other Sharp departments, as necessary, to reduce error rate.Analyze user needs/requirements with a review of department policies/procedures and systems' capabilities.Demonstrate forward thinking by conducting thorough analysis of downstream system impact of issues and proposed solutions.Directs and performs department procedure testing in a timely and accurate manner.
    • ResponsibilitiesResponsible for driving the Sharp Experience culture through values and customer service standards.Accountable for outstanding customer service to all external and internal customers.Develops and maintains effective relationships through effective and timely communications.Conduct impromptu training session's one on one with staff for knowledge sharing to enhance employee work skill processes.Conduct monthly section meetings with staff for job sharing information to enhance staff work skill processes.Ensure staff orientation, training and on-going education/training needs are met and managed up to the Team Lead.Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.Conducts on the job training for the staff with regards to billing activities helping to ensure department process and procedures are effectively understood and followed.Keep Team Lead informed daily of unit/pod workload and employee issues that need Team Lead attention.Researches and identifies complex billing errors, issues and discrepancies and escalates to Team Lead for resolution as needed.Reviews edits/rejections with staff to ensure that all errors are identified and resolved in a timely manner so that claims are sent to and paid by the payers within expected contractual time frames for accurate A/R.Other duties as assigned.Knowledge, Skills, and Abilities
      • Ability to communicate clearly, concisely and accurately both verbally and in writing, to achieve results for the organization with and through people.
      • Ability to mentor PFS analysts, displaying outstanding inter-personal and communication skills.
      • Ability to prioritize multiple tasks and projects and the ability to work independently on multiple projects with minimal supervision.
      • This person must possess the ability to be adept at being an initiator of positive change to support the Mission, Values and Goals for Sharp HealthCare.
      • Must have intermediate knowledge of word processing and spreadsheet applications and practical knowledge of CPT, ICD, HPCS, usage in the billing of physician professional claims.
      • Must be proficient in using Experian contract manager and Eligibility tools.
      • Advanced knowledge of pertinent software applications is preferred and the ability to be able to adjust easily in a healthcare information systems environment.
      • In addition, the Senior Representative is to assist the Team Lead and Manager in maintaining goals set for the department staff.
      • Ability to provide guidance within the department by being the first respondent level to the staff(s) questions and assisting them with problem resolution.
      • Ability to monitor problem appeals, handle first level patient complaint issues, they will help with training and mentoring the staff, and in the absence of the Team Lead, will bring to the interim Team Lead any supervisory issues that would need immediate attention.Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected classH.S. Diploma or Equivalent

Keywords: Careerbuilder-US, Orange , Senior PFS Representative / Patient Financial Services / Full Time / Kearny Mesa, Accounting, Auditing , Orange, California

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