Patient Financial Services Representative - Pharmacy Business Office
Company: UNC Health Care Systems
Posted on: January 15, 2022
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.
Performs a variety of complex duties in support of reimbursement
from patients and insurance carriers.
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
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
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
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.
High School diploma or GED
No licensure or certification required.
Professional Experience Requirements:
Three (3) years of experience in a clerical, accounting or customer
Knowledge/Skills/and Abilities Requirements:
Substantial knowledge of a variety of carrier policies, procedures
and practices is required.
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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