About the role
Initiates and coordinates follow-up activity on assigned accounts with the goal of maximizing reimbursement and ensuring timely cash flow.
Description Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. Today at Penn Medicine, someone will make a breakthrough.
Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?
Job Title: Financial Service Rep Department: Surgery Urology PAH Entity: Clinical Practices of the University of Pennsylvania (CPUP) Location: Penn Medicine Washington Square- 800 Walnut St Hours: M-F, 8-4:30 with flexibility in hours based on operational need
The position of Financial Services Representative is responsible for a broad range of complex billing activities including data entry, payment posting, reconciliation, depositing checks, completing log sheets, accounts receivable functions, billing procedures and accurate record maintenance. Review and take action upon a variety of system-generated status and exception reports related to billing activity, payments, and collections.
Train as back-up coverage for other billing areas within the department.
Responsible for rejections, edits, and accounts receivable for specific payer group(s) work queues as assigned. Initiates and coordinates follow-up activity on assigned accounts with the goal of maximizing reimbursement and ensuring timely cash flow. Resolves rejections related to, but not limited to, correction of registration, submission of documentation, acceptable Correct Coding Guidelines, timely filing, appeal reviews, verification of duplication claims, maximum benefits, rejections due to precertification/ authorization/referral, provider eligibility and other miscellaneous rejections.
Demonstrates success by achieving acceptable collection rates and days in A/R for each type of insurance payer assigned. Demonstrates success in completing target level or above averaged number of accounts per week. Demonstrates knowledge and ability to use third party carrier computerized inquiry systems.
Possess ability to utilize Health System professional billing and hospital patient accounting computerized systems. Uses worksheets from Microsoft Excel and Word. Initiates communication with patients and third party insurance representatives to resolve account balances and performs appropriate action in response to the inquiry.
Calls Insurance Companies to verify details of enrollment, benefits and coverage for in-patient, outpatient and office procedures and visits. Adheres to Health Systems’ write-off, discount and adjustment policies. Prepares reports to assess reimbursement performance.
Maintains updated knowledge and the use of CPUP EPIC APM billing system including, BAR, Registration, PCS, Scheduling and the SMS hospital systems to view account information. Researches and resolves missing charges. Maintains knowledge and ability to use SMS for entity EPIC APM, Navinet etc.
Provides back-up coverage OR Schedules accounting for all anesthesia records for charge entry. Picks up charges from various drop off boxes in different areas of the hospitals. Maintains knowledge of pre-certification to provide back-up coverage.
Performs registrations, charge entry and payment posting as assigned. Maintains current knowledge of third party carrier regulations. Non-essential Accountabilities.
Maintain systems necessary for proper organization of work. Organizes work so that in the event of absence someone else can easily identify areas to continue and/or complete work in progress. Follows workload priority as assigned by the Manager on a daily basis to maximize efficiency.
Adapts to change(s) in workflow to meet the demands of the Department. Demonstrates adaptability by adjusting the workflow to meet current priorities. Provides back-up coverage for co-workers during absences.
Ability to access accounts via automated systems and websites, UPHS Registration, Navinet, etc. Reports major insurance practice changes to supervisor as they occur. Education or Equivalent
H. S. Diploma/GED (Required) And 3+ years Experience in Accounts Receivable; 1 year of this experience must be in a healthcare billing environment.
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region.
Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives. Live Your Life's Work We are an Equal Opportunity employer.
Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.