Patient Financial Services Representative I - York - Days

Full time (40 hours weekly)

Monday-Friday dayshift

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:

• Conducts timely follow-up on patient accounts billed to insurance companies to determine reasons for delayed or missing payments.


• Investigates denied or rejected claims, reviews insurance remittance advice, and identifies reasons for denial.


• Collaborates with insurance carriers, internal billing teams, and other stakeholders to obtain necessary information and documentation to resolve claims.


• Documents findings and actions taken to resolve denials or delays in payment.


• Initiates and manages appeals or resubmissions of denied claims as appropriate.


• Communicates effectively, verbally and in writing, directly with payors to follow up on outstanding claims, files technical and clinical appeals. Resolves payment delays/non-payments to ensure timely and accurate reimbursement.


• Maintains accurate records of follow-up activities and payment status in the billing system.


• Identifies trends in denied claims and recommends process improvements to reduce denials and expedite payment.


• Provides excellent customer service to patients and internal teams regarding billing inquiries and insurance follow-up.

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


• Associates Degree Preferred

Work Experience:

• 1 year Required


• Prior experience in hospital billing, professional billing, or insurance follow-up/denials Preferred

Knowledge, Skills, and Abilities:

• Knowledge of insurance claims processing, payer policies, and medical terminology is essential


• Strong analytical and problem-solving skills to investigate and resolve billing discrepancies


• Excellent verbal and written communication skills for effective interaction with insurance companies and internal teams


• Proficiency with billing software and Microsoft Office Suite (Excel, Word, Outlook)


• Ability to manage multiple accounts and prioritize tasks efficiently in a fast-paced environment


• Attention to detail and commitment to accuracy

Benefits Offered:

• Comprehensive health benefits


• Retirement savings plan


• Paid time off (PTO)


• Education assistance


• Financial education and support, including DailyPay


• Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)