Patient Financial Services Associate – II
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Job Description
Patient financial services associate resolving insurance claims, denials, and billing issues. Supporting Abbott’s global healthcare technologies through Epic-based revenue-cycle operations.
Responsibilities:
- Process claims, appeals, denials, and statements accurately and timely
- Resolve billing discrepancies, eligibility issues, denials, appeals, and aged unpaid claims for commercial, government, and plan coverage
- Communicate insurance information to ancillary departments and ensure appropriate coverage using Epic, external portals, and other software
- Review and resolve payor denials, appeals, and claims with no payor response through portals, calls, and system investigations
- Read and understand explanations of payments to resolve back-end claims
- Verify patient insurance eligibility and investigate and correct accounts within Epic, including demographics, financial, and guarantor information
- Interact with insurers and third-party payors to obtain and document authorization
- Research missing or erroneous account information using portals and other resources, including identifying unknown payors
- Review and edit claims and appeals before clearinghouse submission
- Analyze and resolve claim issues using federal, state, and payor rules and procedures
- Correct rejected claims from claim scrubbers, clearinghouses, or payors
- Analyze explanations of payments and complete appropriate denial resolution steps, including appeals, write-offs, or statements
- Investigate payor underpayments and follow up on unpaid aging claims by phone
- Provide supporting documentation to insurance payors
- Perform accurate and timely write-offs for uncollectible accounts
- Participate in team meetings and share denial trends to improve front-end claim edits and first-pass resolution
- Contribute workflow and best-practice ideas to improve performance, processes, and net revenue collections
- Provide ad-hoc departmental support for special projects, outages, and high-volume periods
- Maintain confidentiality and comply with HIPAA, Quality Management System policies, and procedures
- Complete responsibilities within required timeframes and quality standards
Requirements:
- High School Diploma or General Education Degree (GED)
- 2 years of experience in medical billing, claims, and/or insurance processing
- Extensive and current working knowledge of government, managed care, and commercial insurances claim submission requirements, reimbursement guidelines, and codes
- Knowledge of medical terminology and/or health insurance terms
- Knowledge of EHR operating systems and work involving electronic records
- Proficient in computer systems and keyboarding skills
- Demonstrated strong attention to detail and focus on quality output
- Demonstrated ability to perform the Essential Duties of the position with or without accommodation
- Authorization to work in the United States without sponsorship
- Ability to work Monday through Friday during normal business hours
- Ability to work in front of a computer screen and/or perform typing for approximately 90% of a typical working day
- Ability to work on a computer and phone simultaneously
- Ability to use a telephone through a headset
- Successfully complete an assessment showing understanding of Epic processes with a score of 80% or higher
- Preferred: Related Associate degree or medical billing certification
- Preferred: 4+ years of experience in medical or insurance billing field
- Preferred: Experience with Epic or other EHR application
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