Patient Financial Services Representative 3 - Bilingual

Inova Fairfax Hospital is looking for a dedicated Patient Financial Services Representative 3 - Billingual to join the team. This role will be on-onsite, full-time day shift from Monday - Friday, 8:00 a.m. - 5:00 p.m.

The Patient Financial Services Representative 3 - Billingual performs the duties of a Patient Financial Services Representative 2 and is responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims. Processes claims for at least two payer types (i.e. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.) and ensures that all assigned claims meet clearinghouse and/or payer processing criteria. Ensures appropriate follow-up on assigned work lists while meeting all departmental productivity and quality review standards. Provides team management with issues regarding the claims follow-up process. Ensures that payer response reports and rejection reports are worked on in a timely and meet departmental productivity and quality review standards.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave, and flexible work schedules

Patient Financial Services Representative 3 Job Responsibilities:

• Ensures that all clean claims are submitted the day they are received, submitted via the appropriate medium, and with all required attachments. Reviews claims, identifies/makes corrections or initiates resolution within 24 hours of the date the claim was received.
• Documents and reports claims submission issues immediately and provides feedback to team management regarding issues and wins.
• Provides resolution for pending (WIP backlog) claims within allowable timeframes, as defined for appropriate deficiency, and/or provides appropriate account follow-up based on established protocol or SRGs.
• Completes write-off requests and submits to supervisor for daily review.
• Appropriately documents activity in HealthQuest and TRAC.
• Completes and submits all daily, weekly, and monthly reports with minimal errors.
• Maintains knowledge of payer requirements, UB-04 standards, and system (i.e. Hospital, clearinghouse, payer) functionality in addition to Hospital policies and procedures.
• Ensures documentation is professional, appropriate, accurately depicts actions performed, and is in accordance with departmental quality review standards.
• May perform additional duties as assigned.

Patient Financial Services Representative 3 Requirements:

• Work Schedule: 8-hour shift (Monday - Friday days, 8:00 a.m. - 5:00 p.m.)
• Education: High School or GED
• Experience: Two years of experience in revenue cycle, finance, customer service or data analytics

Patient Financial Services Representative 3 Preferred Requirements:

• Bilingual in Spanish strongly preferred, with the ability to communicate effectively with diverse patient populations.
• Proficiency in hospital billing systems (e.g., Epic) and insurance verification portals.
• Insurance & Compliance Knowledge: Extensive understanding of Medicaid, Medicare, commercial insurance, and self-pay policies. Familiarity with HIPAA regulations and hospital financial assistance programs.
• Analytical & Problem-Solving Skills: Ability to analyze patient accounts, identify discrepancies, and resolve billing or insurance issues effectively.