Position Details

Department: CORP | PFS - Hospital
Category: Patient Financial Services
Location: Scottsdale
Posting #: 559700
Date Posted: 2/18/2021
Employee Type: Regular

Position Summary

This position is responsible for conducting regular analysis of payments received from contracted payers, making quantitative comparisons to determine if the hospital received the appropriate reimbursement, monitoring contractual allowances, analyzing and pursuing appeal opportunities with contracted payers and reporting variance/appeals performance.

PCH Values

  • Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
  • Excellence in clinical care, service and communication
  • Collaborative within our institution and with others who share our mission and goals
  • Leadership that set the standard for pediatric health care today and innovations of the future
  • Accountability to our patients, community and each other for providing the best in the most cost-effective way.

Position Duties

  1. Reviews and analyzes accounts and EOBs to identify under-allowed claims.
  2. Batches, compiles, and submits appeals and monitors payments for proper reimbursement. Documents all variance and appeal activity in the hospital system.
  3. Creates reports to aid in workflow and appeal opportunities and track recovery payments.
  4. Establishes and maintains effective communication with employers, other healthcare providers, insurers, and patient/families to secure accurate and pertinent information to maximize reimbursement.
  5. Monitors and tracks contractual, billing, registration, and posting errors and provides continuous feedback to the department supervisor regarding any consistently under-allowed claims.
  6. Uses good interpersonal skills to promote positive, effective interaction with customers and to promote quality service to ensure flow of information to appropriate staff and professionals.
  7. Verifies applicable contract rates by reviewing EOB messages, patient ID card, and verifying member information for managed care plans.
  8. Performs miscellaneous job related duties as requested.

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Do you meet this requirement?
1. Associate's degree or higher in Healthcare, Business, or closely related field, or equivalent combination of post-secondary education and experience. Preferred
2. Bachelor's degree or equivalent combination of post-secondary education and experience. Preferred
Do you meet this requirement?
1. Two years experience account follow-up, zero payment denials, denial resolution, and underpayment/variance resolution in a healthcare setting. Required
Do you meet this requirement?
1. Credentialed Revenue Cycle Representative Preferred
2. Certified Patient Account Representative Preferred
3. Certified Patient Account Technician Preferred
Do you meet this requirement?
Special Skills
1. Knowledge of managed care contracts, AHCCCS, third party payers and multiple types of reimbursement. Required
2. Ability to identify, analyze, solve problems, and recognize patterns in data. Required
3. Ability to organize and manage detailed processes. Required
4. Knowledge of trending reports related to denials and payment variance. Preferred
Physical Requirements & Occupational Exposure/Risk Potential
1. Physical Requirement - Climbing Occasionally
2. Physical Requirement - Feeling (sensing textures and temperatures) Frequently
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) Frequently
4. Physical Requirement - Hearing Frequently
5. Physical Requirement - Pushing/pulling Occasionally
6. Physical Requirement - Reaching Occasionally
7. Physical Requirement - Sitting Constantly
8. Physical Requirement - Standing Frequently
9. Physical Requirement - Stooping/crouching/kneeling/crawling Frequently
10. Physical Requirement - Talking Frequently
11. Physical Requirement - Tasting/smelling Occasionally
12. Physical Requirement - Walking Frequently
13. Physical Requirement - Near Vision Frequently
14. Physical Requirement - Far Vision Constantly
15. Physical Requirement - Color Discrimination Occasionally
16. Physical Requirement - Use of keyboard, mouse and/or computer equipment Constantly
17. Physical Requirement - Lift up to 35 pounds without assistance Frequently
18. Physical Requirement - Lift more than 35 pounds without assistance Occasionally
19. Occupational Exposure/Risk Potential - Inside office environment Applicable
20. Occupational Exposure/Risk Potential - Confined areas Applicable
21. Occupational Exposure/Risk Potential - Fumes or airborne particles Applicable
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply