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Patient Financial Services Representative - Pharmacy Business Office

Company: UNC Health Care Systems
Location: Durham
Posted on: January 15, 2022

Job Description:

Description
Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.
Summary:
Performs a variety of complex duties in support of reimbursement from patients and insurance carriers.
Responsibilities:


  • Collect delinquent account payments from patients and carriers. Authorized to expedite garnishment of wages for payment of outstanding charges. Collect payment on delinquent accounts by processing forms, generating correspondence, responding to appeals and presenting case at hearings.


  • Contact insurance carriers to obtain authorizations and referral approvals for services and procedures. Research medical records to gather information and substantiate medical justification for procedures as required by insurance carriers. Submits requested medical information to insurance carrier.


  • Evaluate accounts, billing, payments, and posting of accurate charges for a highly specialized and complex medical service such as transplant


  • Maintain data tables for systems that support Patient Accounting operations. Evaluate carrier and departmental information and determines data to be included in system tables


  • May serve as a lead worker to provide problem resolution and assistance to lower level positions.


  • Obtain information from patients to verify insurance coverage and financial status in order to obtain proper reimbursement. In cases of acute patient presentation, obtain identity of patient, insurance information, etc. or follow up with patient for information when patient is coherent.


  • Perform other office/administrative support duties. NOTE This duty should not comprise more than 40% of the position's total duties.


  • Post payments and denials to patient accounts, reconcile accounts, research and resolve a variety of problems relating to posting of payments and charges, insurance denials, secondary billing issues, credit balances, sequencing of charges, and non-payment of claims. Contact patients, physicians and insurance companies to obtain information necessary for account resolution through write-offs, reversals, adjustments, refunds or other methods.


  • Process a variety of forms that may be complicated by legal issues (Psychiatry, patient confidentiality) in accordance with UNCHCS policies and procedures. Input information into variety of systems


  • Research and determine if carrier denial of claim is valid. Abstract information from medical records to support appeal of carrier denials and/or make recommendations to change coding of charges in accordance with ICD-9 and CPT codes. Resolve denials of claims with carriers and patients.


  • Researches, analyzes, resolves and collects patient accounts receivable. Utilizes a variety of systems to analyze insurance and demographic information responds to requests for account information processes a variety of records and reports and contacts third party carriers, patients and employers to resolve outstanding accounts. Accurately documents collection activities performed on outstanding accounts receivable.


  • Serve as a resource for physicians, insurance carriers and patients to resolve questions/ problems pertaining to patient accounts.

  • When dealing with indigent patients, expedite completion of applications for Medicaid and other programs (via GFS) by reviewing applications for accuracy and completeness. Advise patients of programs available to provide coverage and persuades patients to apply. Establish payment plans for patients who have no method of payment when all options are exhausted.

    Other Information
    Other information:
    Education Requirements:
    High School diploma or GED
    Licensure/Certification Requirements:
    No licensure or certification required.
    Professional Experience Requirements:
    Three (3) years of experience in a clerical, accounting or customer service setting
    Knowledge/Skills/and Abilities Requirements:
    Substantial knowledge of a variety of carrier policies, procedures and practices is required.
    Job Details
    Legal Employer: NCHEALTH
    Entity: Shared Services
    Organization Unit: Pharmacy Business Office
    Work Type: Full Time
    Standard Hours Per Week: 40.00
    Work Schedule: Day Job
    Location of Job: US:NC:Durham
    Exempt From Overtime: Exempt: No

Keywords: UNC Health Care Systems, Durham , Patient Financial Services Representative - Pharmacy Business Office, Accounting, Auditing , Durham, North Carolina

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