Patient Financial Service Representative 4 - Underpayment Appeal

Inova Center of Personalized Health is looking for a dedicated Patient Financial Services Representative 4 to join the team. This remote role will be full-time day shift from Monday - Friday, 8:00 a.m. - 4:00 p.m. OR 9:00 a.m. - 5:00 p.m.

The Patient Financial Services Representative 4 is responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims. This position will also process claims for multiple payer types (i.e. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.) and ensure that all assigned claims meet clearinghouse and/or payer processing criteria.

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 4 Job Responsibilities:

• Ensures that all clean claims are submitted the day they are received, submitted via the appropriate medium, and with all required attachments. Serves in the place of the supervisor or manager in their absence.
• Resolves complex issues either through individual actions or by coordinating information/actions of other team members, Patient Accounts staff, other hospital departments, or at the payer level. Seeks assistance from supervisor when needed.
• Ensures that claims are reviewed, corrections are identified/made or resolutions are initiated within 24 hours from the date that claims are received. Identifies the need for and provides support/guidance to other team members to promote their efficiency and productivity.
• Handles complex and/or highest dollar accounts while providing appropriate follow-up based on established protocol or SRGs.
• Ensures appropriate and timely documentation of all account activity while appropriately handling all correspondence within 48 hours of receipt.
• Documents activity in HealthQuest and TRAC and ensures that documentation is professional, appropriate, accurately depicts actions performed, and is in accordance with departmental quality review standards.
• Works payer response reports and rejection reports while ensuring they meet departmental productivity and quality review standards. Maintains knowledge of payer requirements, UB-92 standards, system (Hospital, clearinghouse, payer) functionality, and hospital policies and procedures.
• Takes direction from management to resolve issues in addition to providing support, education, and guidance to team members. Performs duties, as assigned, in the absence of the supervisor or manager.

Minimum Qualifications:

• Education: Associate Degree or an additional three years of experience appropriate to the position under consideration
• Experience: 3 years of Experience in revenue cycle, finance, customer service or data analytics

Preferred Qualifications:

• Extensive experience in underpayment appeal, denial resolution, and payer follow-up, with a strong understanding of complex claims processing and reimbursement workflows.
• Proficiency in EPIC systems for billing, claims submission, and documentation, with demonstrated ability to navigate HealthQuest, TRAC, and payer portals efficiently.
• Proven track record of handling high-dollar and complex accounts, including the ability to analyze payer responses, initiate corrective actions, and escalate issues appropriately to ensure timely resolution.
• Strong working knowledge of payer requirements, billing standards, and clearinghouse protocols, along with up-to-date knowledge of hospital revenue cycle policies and procedures.