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PFS Representative II ID-15913

POSITION QUALIFICATIONS
• Minimum Experience: Minimum 5 years hospital or medical billing experience. 
• Minimum Education: High School Diploma. Bachelors preferred.
• Required Certification/License: N/A
• Tools and Equipment Experience Required: ?Knowledge of health insurance mechanisms and coverage is required. Effective oral and written communications skills (including grammar). Proficient keyboarding, accuracy and math aptitude skills. 
• Competencies: all payer classes
• Physical Requirements and Working Conditions: Lift 5 pounds of records
• Position Reports to: Supervisor, PFS

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• Position Manages: N/A

Performance Expectations
SECTION I ESSENTIAL/PRIMARY DUTIES (40%)

1. Analyze payer underpayments, variances, and denials. Escalate trends, make comprehensive suggestions, and file professional appeals according to our contractual agreements and UT Southwestern policy. This includes timely processing of allocated volume of accounts, based on established production guidelines and time parameters provided for workflow. 
2. Responsible for outbound calls and/or status inquiries via payer's website validating receipt of medical claims and adjudication status within established timeframes. Display competent ability to access, navigate, and manage account information through phone calls and payer websites. Documents all work and calls performed, in accordance to policy. This includes complete contact information, good grammar, and expected outcomes.
3. Display competency and ability to work within client based, research, and UTSW special arrangements. This includes but is not limited to: calculating the physician and hospital share and working with MSP to transfer the physician's share to that department, working with other departments at UTSW to properly invoice clients and bill claims for proper adjudication per our agreements. 
4. Be knowledgeable on all payer types and effectively work on special projects for specific initiatives for account resolution projects. Demonstrate confidence and sound decision making for processing through large volumes of denials, complex accounts, or contractual reviews, as identified from strategic leadership requirements.
5. Make necessary adjustments as required by plan reimbursement.
6. Function as a departmental liaison for billing and collections support for internal and external customers, as required. 

SECTION II ADDITIONAL DUTIES (20%)
1. Utilize systems tools and department resources to achieve production and quality targets for resolution of patient accounts. 
2. Investigates and responds to questions or requests for additional information in a timely and professional manner to ensure proper, timely and accurate payment of patient accounts. 
3. Maintains passing QA Scores
4. Attends in-services, classes and meetings related to all operations to the PFS department. Understands reimbursement of all 3rd party payers.

SECTION III P A C T - Delivering the highest level of service possible, by demonstrating the following: (40%)
- Takes ownership in solving problems effectively, efficiently and to the satisfaction of the patient
- Presents constructive feedback regarding system or process failures and participates in resolution in a proactive and positive manner.
ABILITY, ATTITUDE, APPEARANCE
- Maintains patient confidentiality in accordance with University Medical Center policy.
- Consistently maintains control of feelings, emotions and body language.
- Demonstrates through verbal and non-verbal communications openness to change or new ideas. Willingly learns and adapts to changes in work environment and new work methods as introduced. Demonstrates flexibility to fluctuating workload and effectively prioritizes assignments.
- Exhibits a positive attitude in support of the hospital and management, including decisions made by administration and/or management Treats hospital resources and property with respect and in a manner that reflects awareness of financial responsibility.
- Adheres to all policies and procedures related to safety, infection control, and corporate compliance. Including personal demeanor, appearance, and hygiene that are appropriate for the work environment. 
COMMUNICATIONS AND COMPASSION
- Responds to all reasonable requests in an appropriate and timely manner and communicates in a concise and positive manner. 
-Values diversity within the work environment and consistently deals with all customers in a respectful manner.

TEAMWORK
- Supports teamwork and cooperation with co-workers in daily activities. Readily volunteers assistance to help co-workers complete tasks.
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