Valley Medical Center ยท 2 days ago
PFS Revenue Specialist (2025-1213)
Renton, WA
Full-time
Onsite
Mid Level
$23/hr - $34/hr
3+ years expValley Medical Center is a healthcare provider that is seeking a PFS Revenue Specialist. The role involves managing high dollar balances and handling claims for auto insurance related to non-work injuries, while ensuring timely and accurate follow-up on outstanding balances.
Hospital & Health Care
Responsibilities
Performs timely and accurate follow up of all high dollar outstanding balances; >$20,000 hospital, >$1,500 professional
Completes high dollar report and facilitates bi-weekly high dollar meeting with PFS Leadership to provide current status of outstanding balances
Conducts field visits for completion of patient forms as requested by the insurance payers
Files liens to secure funds on pending TPL claim settlements
Handles workqueues related to newborn eligibility and contacts subscriber to add the patient to policy and/or provide updated insurance information
Researches denied claims from payers to determine steps that need to be taken for the purpose of securing payment; including but not limited to drafting appeal letters, interacting with department personnel, third party payers, attorneys and patients
Maintains knowledge of state and payer requirements as a fundamental business practice responsibility under Valley Medical Center's Corporate Compliance program. Reports payor changes to Manager as appropriate
Works collaboratively and promotes an amicable working environment developing effective working relationships with key associates (HIM, Patient Access, Hospital & Clinic Departments)
Reviews Explanation of Benefits (EOB's) and vouchers, to pursue payment of claims
Responsible for ensuring accounts are reimbursed properly to include contacting the appropriate insurance company to secure and expedite payments through the follow-up and appeals resolution processes
Understands and adheres to all federal, state, and local payer-billing requirements
Contacts insurance company/ third parties, patients, physicians and/or departmental staff to obtain necessary or missing information
Identify, analyze and resolve payment barriers
Contacts payers and attorneys to collect outstanding payments
Demonstrated knowledge of the current functionality of patient accounting systems
Clearly documents activities and notes accounts as appropriate in all systems
Responds to requests for information, supporting documentation and other activities required to expedite and receive payment on claim
Responsible for editing patient insurance information on accounts in accordance with the policy and procedure
Communicates any content deficiencies or contracting issues to Leadership
Contacts insurance company/ third parties, patients, physicians and/or departmental staff to obtain necessary or missing information
Identify, analyze and resolve payment barriers
Contacts payers and attorneys to collect outstanding payments
Demonstrated knowledge of the current functionality of patient accounting systems
Clearly documents activities and notes accounts as appropriate in all systems
Responds to requests for information, supporting documentation and other activities required to expedite and receive payment on claim
Responsible to transfer account status to self-pay, request adjustments for administrative, charity care, special patient care scholarship programs when appropriate for account resolution
Pulls itemized statements and Explanation of Benefits as necessary for claim submission, rebilling or appeal
Clearly documents activities and notes accounts as appropriate in all systems
Responds to requests for information, supporting documentation and other activities required to expedite and receive payment on claim
Faxes and / or mails account information to the insurance companies when appropriate
Outgoing correspondence (internal or external) must be written in a clear, concise, and professional manner
Informs Technical Coordinator of system issues to enhance process
Escalates any issues or concerns regarding individual insurance companies, including problem accounts when appropriate intervention is required
Returns all phone calls within 24 hours of receipt of message
Utilizes payer / provider instruction (online) manuals and bulletins, hospital policy / procedures, and other resource materials
Participate in and attend meetings and training as required
Cross-trains for other related business office functions to ensure smooth operation of the department. May be assigned duties across functional areas as needed
Maintains a consistent level of production that is within department standards
Facilitate proper escalation of accounts and patients' concerns when necessary
Documents receipt of audits and audit outcome at the account level
Adheres to policies, procedures and objectives as required by VMC
Maintains confidentiality of all protected health information
Performs all job functions in a manner consistent with Valley's expectations as defined in Valley Values
Performs Other Related Job Duties As Required
Qualification
Required
High school graduate or equivalent (G.E.D.)
Three or more years' experience in health care industry
Three or more years' experience in customer service
Experience in successfully managing receivables with high dollar balances (>$20K)
Data entry skills and intermediate knowledge of Excel, Word and Outlook
Experience in Community Outreach, including visits to patient's home and/or place of business
Possess a valid driver's license and a driving record with no moving violations
Access to a working vehicle required for field visits
Excellent organizational and time management skills
Is flexible, adaptable, and can effectively cope with change
Demonstrates skills in typing and use of personal computers
Experience with analyzing EOB's from various insurance companies/payers
Excellent customer service skills
Demonstrates effective communication and interpersonal skills within a diverse population
Demonstrates the ability to communicate effectively in English, including verbally and in writing
Practices active listening and uses a variety of questioning techniques
Demonstrates the ability to convey information fluently, interpreting and clarifying details and explaining rationale
Able to prioritize tasks, carry out assignments independently and within a team
Demonstrate a commitment to the organizational values by displaying a professional attitude and appropriate conduct in all situations
Neat and well groomed in appearance
Regular and punctual attendance is a condition of employment
Preferred
Post high school college or training
Experience in handling both hospital and professional claims
Experience in follow up and denial resolution of various financial classes
Experience filing documents with state and federal agencies
Prior experience with Epic, Epremis, and Chartmaxx
Company
Valley Medical Center
Valley Medical Center is the largest nonprofit healthcare provider between Seattle and Tacoma.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Michele Forgues-Lackie MBA, FACHE, FACMPE, CHFP
SVP/CFO, UW Medicine's Valley Medical Center
Liz Nolan
SVP Chief Communications & Marketing Officer
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