PFS Billing Representative | Full Time | Day

Summary

The Patient Financial Services (PFS) Billing Representative is responsible for accurate and timely billing and/or follow up of hospital and/or professional claims to third-party payers and patients. This role ensures compliance with federal, state, and payer-specific regulations while maximizing reimbursement and maintaining excellent customer service standards.

Education

High school diploma or equivalent (GED).

Certification, Registration & Licensure

None required.

Required Qualifications

• High school diploma or GED required

• Strong computer skills (Microsoft Office, billing software).

• Excellent analytical, organizational, and problem-solving skills. Strong written and verbal communication skills.

Preferred Qualifications

• 1—3 years of medical billing or healthcare revenue cycle experience

• Experience with hospital-based billing (inpatient, outpatient, or emergency services).

• Knowledge ofUB-04 and CMS-1500 claim forms.

• Knowledge of CPT, ICD-IO-CM, and HCPCS coding principles (basic understanding).  Experience with hospital billing systems and electronic health records (EHR).

Work Environment

• Training in office is required.

• Once trained there are a variety of options depending on skill, training and hospital requirements: in office, at home or hybrid (mix of in office and home). May require occasional overtime to meet billing deadlines.

Responsibilities

Billing Operations - Prepare, review, and submit electronic and paper claims to insurance carriers and government payers depending on assigned team. Ensure claims are compliant with CMS, Medicare, Medicaid, and commercial payer guidelines as appropriate for team. Monitor claim status and resolve claim edits, rejections, and denials in a timely manner. Submit corrected claims and appeals as needed.

Account Management - Follow up on unpaid, underpaid, or denied claims as assigned. Research and resolve billing discrepancies.

Prepare and submit appeals with appropriate documentation. Document all actions and activities taken in the billing system.

Maintain productivity and quality benchmarks. Timely and accurate management of all assigned work Queues.

Customer Service - Respond to insurance inquiries regarding claim processing/issues. Provide clear, professional communication to all customers while maintaining patient confidentiality. Provide accurate, timely feedback to Patient Account Resolution staff regarding patient inquiries.

Compliance - Adhere to HIPAA regulations and hospital policies.

Maintain confidentiality of protected health information (PHI). Stay current on payer updates, state and federal billing regulations, and reimbursement procedures.

Teamwork - Collaborate with team members on a daily basis by sharing information and assistance as needed. Assists with team members' responsibilities in their absence. Works cooperatively to resolve billing issues with other teams including but not limited to: Provider Offices, Patient Account Resolution, Hospital Departments and Registration.

Technology - Up to date knowledge of systems used by PFS to include but not limited to: Cerner, payer websites, Availity, MMIS, Connex, FISS, FinThrive, Policy Tech and Microsoft Office Products as applicable.

Concord Hospital is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race, color, religion, sex, sexual orientation, gender, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.

Know Your Rights: Workplace Discrimination is Illegal

Applicants to and employees of this company are protected under federal law from discrimination on several bases. Follow the link above to find out more.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, you may contact Human Resources at 603-230-7269.

Physical and Work Requirements

The physical demands and characteristics of the work environment described here are representative of those that will be encountered by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The Dictionary of Occupational Titles Material Handling Classification is SEDENTARY. The employee must regularly lift, carry or push/pull less than 10 pounds, frequently lift, carry or push/pull less than 10 pounds, and occasionally lift, carry or push/pull up to 10 pounds.

While performing the duties of this Job, the employee is regularly required to do repetitive motion, hear, and sit. The employee is frequently required to do fine motor, reach, and speak.

Specific vision abilities required by this job include far vision, and near vision.

The employee is occasionally exposed to moving mechanical parts.

The noise level in the work environment is usually moderate.