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PFS Representative II

Billing Specialist | Dallas, TX | Contract

Job Description
PFS Representative II
Work Location: Dallas, TX

Job Duties/Responsibilities/Functions (including but not limited to)
• Analyze payer underpayments, variances, and denials. Escalate trends, make comprehensive suggestions, and file professional appeals according to our contractual agreements and UT Southwestern policy. This includes timely processing of allocated volume of accounts, based on established production guidelines and time parameters provided for workflow.
• Responsible for outbound calls and/or status inquiries via payer’s website validating receipt of medical claims and adjudication status within established timeframes. Display competent ability to access, navigate, and manage account information through phone calls and payer websites. Documents all work and calls performed, in accordance to policy. This includes complete contact information, good grammar, and expected outcomes.
• Display competency and ability to work within client based, research, and special arrangements. This includes but is not limited to calculating the physician and hospital share and working with MSP to transfer the physician's share to that department, working with other departments to properly invoice clients and bill claims for proper adjudication per our agreements.
• Be knowledgeable on all payer types and effectively work on special projects for specific initiatives for account resolution projects. Demonstrate confidence and sound decision making for processing through large volumes of denials, complex accounts, or contractual reviews, as identified from strategic leadership requirements.
• Make necessary adjustments as required by plan reimbursement.
• Function as a departmental liaison for billing and collections support for internal and external customers, as required.
• Utilize systems tools and department resources to achieve production and quality targets for resolution of patient accounts.
• Investigates and responds to questions or requests for additional information in a timely and professional manner to ensure proper, timely and accurate payment of patient accounts.
• Maintains passing QA Scores
• Attends in-services, classes and meetings related to all operations to the PFS department. Understands reimbursement of all 3rd party payers.
• Performs other duties as assigned.

Minimum Qualifications
• High School Diploma. Bachelors preferred.
• Minimum 5 years hospital or medical billing experience.
• Knowledge of health insurance mechanisms and coverage is required.
• MUST have experience with or familiar with the following: Values codes, UB-O4, Claim Edits, Conditions Codes, Occurrence Codes, Acknowledgements of Insurance payers, third party administrations of payers, Combine rules, Timely filing rules.
• Must be familiar with Medicaid and Medicare billing guidelines and Managed Medicare and Medicaid billing guidelines
• Effective oral and written communications skills.
• Proficient keyboarding, accuracy and math aptitude skills.

About InGenesis
InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.

EEOC Statement
We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.