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Patient Financial Services Representative I - Claim Edits - Day

Location: WellSpan Health, York, PA

Schedule: Full Time

General Summary

Completes assigned revenue cycle tasks. Assists in the completion of submitting electronic and/or manual insurance claims, resolves claim edits, performs insurance account follow-up, researches claim denials for resolution and submits disputes and appeals when necessary. Represents the System in a professional manner while interacting with peers, leaders, patients, and third-party payers to achieve timely payment on accounts in accordance with current government and payer regulations.

Duties and Responsibilities

Essential Functions:

• Corrects financial and demographic information that has been inaccurately entered into Epic.

• Performs various functions to complete and expedite the billing process including: - Reviews and submits Hospital and/or Physician claim forms (UB04, 1500, etc) to insurance companies via electronic or manual processes and facilitates special billing for split claims, ancillary charges, interim bills, etc.- Resolves Claim edits to facilitate timely billing and reimbursement.- Performs follow-up with insurance companies to obtain claim status, payment information and to resolve claim discrepancies.- Submits itemized bills, medical records, and corrected claims as needed.- Reviews remittance advice (835) to ensure proper reimbursement.- Accesses external payer sites for payer policies, claim investigations, and claim disputes.

• Reviews accounts and coordinates with appropriate departments on accounts requiring precertification, preauthorization, referral forms and other requirements related to managed care.

• Makes written and/or verbal inquiries to third party payers to reconcile patient accounts. Follows up on accounts until zero balance or turned over for collection.

• Reviews third party payer payments and investigates accounts not paid as expected. Takes appropriate corrective action to include follow up, rebilling, and/or adjustment of contractual allowances.

• Answers all inquiries regarding patient accounts.

Common Expectations:

• Maintains appropriate records, reports, and files as required.

• Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards.

• Participates in educational programs and in-service meetings.

• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

• High School Diploma or GED Required

Work Experience:

• 1 year Required

Knowledge, Skills, and Abilities:

• Excellent communication and interpersonal skills

• Familiarity with payer rules and policies

• Familiarity with healthcare billing systems (Epic preferred)

• Familiarity with medical and billing terms to help interpret edit resolution, claims remittance advice, medical record documentation and payer medical/payment policies

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At WellSpan Health, we are committed to treating all applicants fairly and equitably, regardless of their job classification. If you require assistance or accommodation due to a disability, please reach out to us via email atcareers@wellspan.org. We will evaluate requests for accommodation on a case-by-case basis. Please note that we will only respond to inquiries related to reasonable accommodation from this email address. Rest assured, all requests for assistance or accommodation are handled confidentially, allowing applicants to share their needs openly and honestly with us.

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.