The Patient Financial Services Associate I (PFSAI) position is responsible for the accurate and timely processing of claims, appeals, denials, and statements for Exact Sciences. A PFSAI demonstrates medical insurance knowledge by resolving billing discrepancies, eligibility, denials, appeals, and aged unpaid claim follow up for commercial, government, and plan coverage for optimal Account Receivable (AR) outcomes. PFSAI communicates insurance information to ancillary departments and ensuring appropriate coverage by utilizing Epic, external portals, and other software; reviews and resolves payor denials, appeals, and claims with no response from the payors via portals, calls to payors, and system investigations to ensure accurate claim resolution; reads and understands explanations of payments to resolve back end claim resolution.
- Independently determine initial or ongoing patient insurance eligibility verification, investigate, and correct accounts within Epic; including updates to patient demographics, financial information, and guarantor information.
- Ability to interact with various insurances/third party payors accurately and timely to ensure authorization is obtained and documented based on internal and external policies and regulations.
- Research missing or erroneous information on accounts using various portals and other resources; including outreach and identification of unknown payors.
- Review and/or edit claims and appeals prior to submitting to clearinghouse.
- Analyze, research, and resolve claim issues applying federal, state, and payor rules and procedures with a high degree of independence.
- Corrects claims rejected from the claim’s scrubber, clearinghouse, or payor.
- Reviews explanations of payments, analyzes, and completes appropriate steps for all denials by appropriately identifying claim resolution next steps; including appealing, writing off, or sending statements.
- Investigates payor underpayments.
- Follows up with payors via phone on unpaid aging claims.
- Reviews denials and determines appropriate next actions; such as sending appeals or patient statements.
- Provide ad-hoc support, as necessary, within the department (e.g., special projects, provide support due to outages/high volume, etc.).
- Complete position responsibilities within the appropriate time frame while adhering to quality standards.
- Stay current with relevant medical billing regulations, rules, and guidelines.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Complete other duties as assigned.
- Excellent problem-solving abilities and organizational skills.
- Ability to communicate effectively with all levels of staff through both verbal and written communications.
- Ability to work in a team environment.
- Ability to adapt to changing workload and circumstances effectively; able to respond to new information quickly.
- Disciplined, self-motivated and reliable.
- Ability to stay focused on a task and work independently; motivated to perform quality work.
- Diligent about arriving to work on time and completing tasks that are assigned in a timely manner.
- Conducts self in a professional manner in all interactions with members of the Exact Sciences Clinical Laboratory team, clients, and associates.
- Possess a positive attitude.
- Work with others in a spirit of teamwork and cooperation.
- Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
- Support and comply with the company’s Quality Management System policies and procedures.
- Regular and reliable attendance.
- Ability to work normal schedule of Monday through Friday during normal business hours.
- Ability to work in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
- You will be required to successfully complete an assessment showing understanding of Exact Sciences Epic processes necessary to the job functions with a score of 80% or higher. Exact Sciences will make a reasonable accommodation available if necessary to assist an employee with a disability to satisfy this requirement.
Why Work Here?Since 1946, Spherion has placed millions of talented individuals in rewarding administrative, clerical, light industrial, customer service, non-clinical healthcare and professional jobs. Filling a broad mix of flexible, temp-to-hire and direct hire positions, Spherion is a trusted recruiting and staffing partner to more than 3,000 companies nationwide.
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