The Patient Financial Services (PFS) Team Lead is responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims. Processes claims for at least one payer type (e.g. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.). Ensures that all assigned claims meet clearinghouse and/or payer processing criteria. Provides appropriate follow-up on assigned work lists while ensuring that all work meets departmental productivity and quality review standards. Performs duties, as assigned, in the absence of the supervisor or manager.
Job Responsibilities
- Submits all clean claims the day they are received via the appropriate medium and with all required attachments.
- Ensures that claims are reviewed, corrections identified/made or resolution initiated within 24 hours from the date claims are received.
- Handles complex and/or highest dollar accounts and provides appropriate follow-up based on established protocol.
- In accordance with departmental quality review standards, ensures that documentation is professional, appropriate, and accurately depicts actions performed. Identifies issues with payer rejections and provides feedback regarding rejections to management.
- Initiates resolution to issues and/or seeks/takes direction from management to resolve issues as appropriate.
- Maintains knowledge of payer requirements, UB-92 standards, system (e.g. Hospital, clearinghouse, payer) functionality, and hospital policies and procedures. Serves in a supervisory role, as needed, in the absence of the supervisor and/or manager.
- Ensures that all daily, weekly, and monthly reports are complete and submitted timely, at least 80 percent of the time, and with minimal errors. Documents and reports claim submission issues immediately and provides feedback to management regarding issues/wins.
- Provides resolution for pending (WIP backlog) claims within allowable timeframes. Resolves complex issues either through individual actions or by coordinating information/actions of other team members, other Patient Accounts staff, or the appropriate individuals in other departments.
- Oversees and assists team members in assigned functional area, which may include but not limited to, ensuring team is meeting key-deliverables and quality standards, addressing and resolving challenges, managing and tracking performance, and assisting in time management and scheduling; escalates issues to senior leaders as needed.
- May perform additional duties as assigned.
Additional Requirements
Experience - Three years of experience in cash entry, Electronic Remittance Advice (ERA) retrieval/posting, cash posting, banking lockbox support, revenue cycle, finance, customer service, data analytics or refund/credit balance review.
Education - High School or GED
We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 24,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare.
Inova Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.
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