Patient Access Financial Representative - Memorial Health

Under the general and direct supervision of the Patient Access Manager, our Patient Access Financial Representative is responsible for addressing patient concerns related to service and procedure charges, insurance billing and reimbursement, and all other financial transactions associated with patient accounts.

The representative provides payment options, collects patient balances as appropriate, and effectively triages, documents, and initiates referrals to Springfield Memorial Hospital's Medicaid vendor and for financial assistance, in accordance with the Illinois Fair Patient Billing Act, the Illinois Uninsured Patient Discount Act, and established procedures of Springfield Memorial Hospital and Patient Financial Services.

Additionally, the Patient Access Financial Representative is responsible for maintaining knowledge of JCAHO standards, Patient Rights and Responsibilities, HIPAA compliance, and the requirements of Managed Care, Commercial, and government payers, as well as departmental and Health System policies and procedures.

This role may also require occasional travel to other affiliate locations.

Education:

• High school diploma required.

Licensure/Certification/Registry:

• Certification through Healthcare Business Insights (HBI) is required upon hire and must be maintained every two years.

Experience:

• One (1) year of business office experience is preferred, particularly in Patient Access, billing, collections, insurance principles/practices, or accounts receivable. Previous experience in Patient Financial Services is highly desirable.
• Completion of twelve (12) hours of coursework in a business or healthcare-related field may be considered in lieu of business office experience.
• Cerner systems experience is preferred.

Other Knowledge/Skills/Abilities:

• Knowledge of medical terminology, medical procedural coding (CPT), HCPCS, CCI Edits, diagnosis coding (ICD-10 CM), revenue codes, as well as UB-04 and Explanation of Benefits (EOB) interpretation.
• Proficient with computers, including the ability to enter and retrieve data, and electronically document using patient accounting software and other required applications/systems.
• Ability to work successfully with internal and external customers.
• Detail-oriented with strong critical thinking and problem-solving skills.
• Excellent oral and written communication skills, with the ability to maintain a calm and professional demeanor in high-stress situations.
• Flexible, demonstrating sound judgment and initiative in stressful situations, with the ability to manage competing priorities and work independently in a rapidly changing environment.
• Ability to educate, persuade, and negotiate effectively with patients and families.

Annual Credentialing Requirements:

• Must successfully complete assigned annual education through Healthcare Business Insights.

• Customer Assistance:
  Assist patients and others with account issues by explaining and coordinating resolutions for billing, private pay options, collection efforts, coordination of benefits, and insurance coverage. Serve as a liaison between external resources and patients.

• Negotiation and Payment Collection:
  Negotiate with patients and families to explain, collect, and record payments and deposits using electronic payment systems. Process cash, checks, and credit card transactions as appropriate, ensuring the accuracy and security of the cash drawer and all cash equivalents.

• Cash Reconciliation:
  Reconcile cash accounts and resolve discrepancies. Prepare bank deposits for pickup and pursue account balances and payments in alignment with Patient Financial Services policies to maximize reimbursement.

• Relationship Building:
  Build strong working relationships with assigned business units, hospital departments, and provider offices. Identify trends in payment issues and communicate effectively with internal and external customers to educate and resolve problems.

• Complex Issue Resolution:
  Research and resolve complex issues related to patient accounts. Document and report problematic trends to management while collaborating with the patient financial services team to reduce outstanding accounts receivable balances.

• Account Management:
  Review and consolidate multiple accounts for individual patients. Explain available payment options and establish appropriate payment plans according to departmental policies and procedures.

• Documentation:
  Accurately record all customer visits to the Lobby Office, ensuring proactive discussion of all patient accounts. Log and batch accounts according to established procedures.

• Collection Activity Reporting:
  Thoroughly document all collection activities performed and complete/send daily account payment reconciliation reports to the appropriate teams within the Springfield Memorial Hospital Finance Department.

• Coordination:
  Coordinate with Springfield Memorial Hospital Patient Financial Services, Utilization Management, physicians, and medical offices to ensure consistent financial documentation and a cohesive approach to patient and organizational needs.

• Account Prioritization:
  Identify, prioritize, and resolve problematic accounts, verifying patient eligibility for potential payer sources and financial assistance.

• Benefit Eligibility Analysis:
  Analyze reports from various hospital sources to resolve benefit eligibility concerns and determine suitability for financial assistance. Initiate coverage acquisition as appropriate.

• Training and Cross-Training:
  Orient and cross-train others within the assigned area as directed by management. Understand the functionality of all related computer systems and assist other areas during times of need.

• Interpersonal Skills:
  Demonstrate superior patient relations and interpersonal skills, maintaining a calm and even temperament when interacting with staff, patients, and the public. Promote a positive work environment and contribute to the overall team efforts.

• Additional Duties:
  Perform other related duties as required or requested.