Patient Financial Services Representative III

Job Overview

Fairview is looking to hire a Patient Financial Services (PFS) Representative III to join our Revenue Cycle team! This is a full-time, 1.0 FTE (80 hours per two-week pay period), benefit-eligible position working Monday through Friday, 8 hours per day, with home-based flexibility.

As a PFS Representative III, you will be responsible for managing complex accounts receivable, insurance follow-up, and resolving outstanding claims to ensure accurate and timely reimbursement. This position focuses specifically on Special Guarantor accounts, working with unique payers and specialized billing requirements. Responsibilities include researching account discrepancies, resolving denials, communicating with payers, and collaborating with internal teams to ensure accounts are appropriately resolved.

The ideal candidate will have previous healthcare billing and insurance follow-up experience, strong working knowledge of Epic, and the ability to navigate complex payer requirements. Familiarity with Special Guarantor accounts is highly preferred, and experience with professional claims billing and follow-up is a plus. Strong organizational skills, attention to detail, and the ability to work independently while meeting productivity and quality expectations are essential.

This position is responsible for billing and collection of accounts receivable for inpatient and outpatient accounts, ensures expected payment is collected and accounts are fully resolved, and resolves complex customer service issues. This position understands the importance of evaluating and securing all appropriate financial resources for patients to ensure proper adjudication. 

Responsibilities

• Intentionally prevents untimely revenue shortfalls by taking action to resolve financial transactions appropriately and effectively to ensure collection of expected payment; escalates issues when appropriate.
• Completes daily work assignment timely and accurately in accordance with the identified productivity and quality standards set forth by the organization.
• Performs the best practice routine per department guidelines.
• Proactively looks for continuous process improvements involving people and technologies through tracking, trending, and providing feedback.
• Accelerates business outcomes by identifying ways to fully resolve accounts through single-touch resolution when possible.
• Understands revenue cycle and the importance of evaluating and securing all appropriate reimbursements from insurance or patients.
• Contacts payers via portal or provider service center to facilitate timely and accurate resolution of accounts.
• Responsible for processing external correspondence in a timely and efficient manner.
• Ensures internal correspondence is clearly and professionally communicated and processed expeditiously.
• Responsible for verification of insurance and/or patient demographics
• Understands expected payment amounts and Epic expected payment calculations to appropriately adjust accounts.
• Educates patients and/or guarantors of patient liability when appropriate.
• Understands and complies with all relevant laws, regulations, payer and internal policies, procedures, and standards, and applies this understanding through daily work
• Responsible for processing accounts through multiple workflows
• Responsible for working accounts requiring more attention to detail
• Advanced knowledge of team procedures, standards, and policies, and applies this knowledge through daily work.
• Makes appropriate contacts with payers and other necessary parties to obtain and/or provide data or information needed to facilitate timely and accurate account resolution to expedite outcomes.
• Utilizes strong understanding of multiple systems/applications to ensure collection of expected payment.
• Utilizes knowledge of internal and external departmental functions and workflows to expedite and resolve when necessary.
• Responsible for in depth investigation and resolution of complex accounts
• Utilizes public speaking skills through high engagement in discussions and meeting facilitation.
• May be assigned complex responsibilities/projects that require senior leadership visibility or approval.
• Acts as a key resource to the team by mentoring staff and/or supporting the lead.
• Responsible for detailed analysis and processing of correspondence to facilitate improved collection processes.
• Maintains, complies, and shares knowledge of all relevant laws, regulations, payer and internal policies, procedures and standards.
• Extensive knowledge of other areas within the department to provide support as needed.

Required Qualifications

• 2 years in a medical billing office setting or relevant experience
• Organizational skills
• Communication skills
• Attention to detail

Preferred Qualifications

• 2 years of medical billing office setting experience
• MS Office experience
• Coordination of benefits experience
• Epic, Brightree, Billing Bridge, or comparable software account experience
• Experience working with medical terminology
• Experience working with CPT-4 and ICD-10
• Extensive knowledge of FV account review experience
• Extensive knowledge of FV system applications
• Extensive knowledge of FV RCM workflows
• Billing certification
• Substantial system super user experience

Benefit Overview

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link for additional information: https://www.fairview.org/careers/benefits/noncontract

Compensation Disclaimer

An individual's pay rate within the posted range may be determined by various factors, including skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization prioritizes pay equity and considers internal team equity when making any offer. Hiring at the maximum of the range is not typical. If your role is eligible for a sign-on bonus, the bonus program that is approved and in place at the time of offer, is what will be honored.
EEO Statement

EEO/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status