IMH PFS Representative, Full Time -Days

Be a part of a world-class academic healthcare system , Ingalls Memorial as a PFS Representative. This is a remote, work from home opportunity and you may be based outside of the greater Chicagoland area.

This position is responsible for collections and final resolution of insurance claims, maintains records and reports in accordance with department procedures, meets productivity and quality standards, governing the collection process as defined by the hospital procedures. This position understands and maintains all State and Federal regulation related to billing and collections. All staff in Patient Financial Services are classified under the general title of IMH Patient Financial Services Representative, although position responsibilities and requirements vary based on specific assignment.

Essential Functions

• The Patient Financial Services Representatives responsible for Medicare, Medicaid and commercial billing will be responsible for processing claims in accordance with state regulatory directives. This role involves ensuring government standards are adhered to and incumbent to possess continual knowledge regarding new legislation and regulations. Billing rules and processes, standards and regulations must be followed in order to be compliant. Depending on certain aspects of these positions, claims and rejections will be worked/processed in the billing system on a daily basis to ensure timely filing limits.

• The Patient Financial Services Representative responsible for collections will be responsible for contacting

  third parties, insurance companies, attorneys and patients in an effort to collect payments due for services rendered. Follow up will be done at monthly intervals with a focused effort on large dollars and aging accounts. Work is done in an alpha split with the expectation of a team effort to achieve department goals.

• Accounts Receivable Specialist are responsible for daily processing of charity, self-pay discounts, refunds, mail, and a variety of other reports related payments and adjustments to maintain our patients billing process to ensure timely statements are received. This is a clerical position that requires great attention to detail, speed and accuracy. Cash app falls under this group and is responsible for locating missing or unallocated payments, scanning, bank deposits and researching to resolve posting matters related to PFS.

• The denial team is responsible for processing short pays, refunds and denials received from payers. The denial representative is responsible for verifying the contract and/or working in the denial system to process/refer the denials correctly. Appeals will be processed dependent on the type of the denial.

• Insurance Collections Average 12 accounts per hour and are responsible for non- government payers.

• A/R Cash 120% of prior two months net revenue

• Q/A review will be completed on 5 accounts per month

• Documents all actions regarding account resolution in a comprehensive and concise manner and in accordance to department requirements\

• Seeks assistance for additional options when account resolution has come to a standstill

• Maintains and complies with regulatory requirements

• Offers ideas in writing to streamline improve procedures

• Offers and develop method to identify cost savings

• Zero tardiness including forgot to clock in and/or out

• Reviews all previous account documentation and utilizes information for effective account resolution

• Billers and Denial unit staff must maintain Medicare/Medicare ( government ) knowledge

  through personal education and development

• Documents all actions in financial system

• Reporting payment discrepancies

• Performs other duties as assigned

• Balances accounts Works online work list daily

Required Qualifications

• High school graduate or equivalent is required
• Two year hospital business office experience preferred
• Ability to interpret contracts, state and federal programs to determine proper reimbursement
• State and Federal regulations regarding HIPPA, billing and collection
• Knowledge of UB04, 837I, 837P, 835, ICD10, and rev codes
• Medicare, Medicaid and Managed Care Billing/Denial Representatives – Requires 1-2 years prior experience working directly with Medicare/Medicaid Claims
• Required: Knowledge of Microsoft Excel, Word and Outlook
• Required: Typing 30 words per minute
• Required: Ten key calculators
• Required: Demonstrates good verbal, written, and comprehension skills
• Required: Ability to follow and complete detailed directions
• Required: Supports an environment of team work Required: Ability to work independently as well as part of a team

Preferred Qualifications

• Preferred: Medical Terminology
• Preferred: Medicare/Medicaid, and Managed Care claims processing in a hospital environment. Preferred: Experience with Passport/NEBO/FSS0

Position Details:

• Job Type/FTE: Full Time (1.0 FTE)
• Shift: Days
• Unit/Department: Patient Care
• Work Location: Remote/ Burr Ridge, IL (Must be able to commit to training onsite)
• CBA Code: Non-Union