This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.

Role Description

Inova Health is looking for a dedicated Patient Financial Services Representative 4 - Customer Service to join the team. This role will be full-time day shift from Monday - Friday, 9:30am - 6:00pm, Remote Role.

Remote Eligibility: This position is eligible for remote work for candidates residing in the following states - VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV.

The Patient Financial Services Representative 4 performs the duties of a Patient Financial Services Representative 3 and is responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims:

• Processes claims for multiple payer types (i.e. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.)
• Ensures that all assigned claims meet clearinghouse and/or payer processing criteria.
• Ensures appropriate follow-up on assigned work lists while meeting all departmental productivity and quality review standards.
• Informs management of issues and potential resolutions regarding problems with the claims process.
• Provides support, education, and guidance to team members while performing duties, as assigned, in the absence of the supervisor or manager.

Responsibilities

• Ensures that all clean claims are submitted the day they are received, submitted via the appropriate medium, and with all required attachments.
• Serves in the place of the supervisor or manager in their absence.
• Resolves complex issues either through individual actions or by coordinating information/actions of other team members, Patient Accounts staff, other hospital departments, or at the payer level.
• Seeks assistance from supervisor when needed.
• Ensures that claims are reviewed, corrections are identified/made or resolutions are initiated within 24 hours from the date that claims are received.
• Identifies the need for and provides support/guidance to other team members to promote their efficiency and productivity.
• Handles complex and/or highest dollar accounts while providing appropriate follow-up based on established protocol or SRGs.
• Ensures appropriate and timely documentation of all account activity while appropriately handling all correspondence within 48 hours of receipt.
• Documents activity in HealthQuest and TRAC and ensures that documentation is professional, appropriate, accurately depicts actions performed, and is in accordance with departmental quality review standards.
• Works payer response reports and rejection reports while ensuring they meet departmental productivity and quality review standards.
• Maintains knowledge of payer requirements, UB-92 standards, system (Hospital, clearinghouse, payer) functionality, and hospital policies and procedures.
• Takes direction from management to resolve issues in addition to providing support, education, and guidance to team members.
• Performs duties, as assigned, in the absence of the supervisor or manager.
• May perform additional duties as assigned.

Qualifications

• Education: Associate Degree or an additional three years of experience appropriate to the position under consideration.
• Experience: 3 years of experience in revenue cycle, finance, customer service or data analytics.

Preferred Qualifications

• Bilingual (English and Spanish) strongly preferred to better support a diverse patient population.
• Deliver exceptional customer service by addressing patient inquiries with professionalism, empathy, and clear communication.
• Utilize EPIC to review, update, and maintain accurate patient account information.
• Support a positive patient experience by assisting patients with billing questions, insurance coverage, and financial responsibilities.
• Review and interpret Explanation of Benefits (EOBs) to resolve patient or insurance discrepancies.
• Collaborate with insurance providers to verify coverage, process claims, and ensure timely resolution of billing issues.
• Demonstrate openness to feedback and continuously adapt to improve service quality and efficiency.
• Perform effectively in a remote work environment, maintaining productivity and accountability.

Benefits

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules.