Prisma Health · 1 day ago
PFS Billing Rep, FT, Days
Greenville, SC
Full-time
Onsite
Mid Level
3+ years expPrisma Health is dedicated to transforming healthcare for the benefit of the communities they serve. The PFS Billing Rep is responsible for the accurate and timely submission of claims to various payer sources, ensuring follow-up on specialty accounts and resolving issues related to payment denials and discrepancies.
Health CareHospitalMedical
Responsibilities
Works and processes the Billing functions, including resolving the Discharged Not Final Billed/Stop Bill errors that prevented the account from billing, the resolution of Claim Edits in order to submit to our Claims Clearinghouse for electronic submission. Also processes the daily paper claims submissions for primary and secondary claims
Follows up on Specialty AR accounts assigned to determine if the claim has been accepted and processed for payment or denied. Reviews claim rejections and re-bills accounts when appropriate. Effectively and timely identifies the root cause of non-payment denials and works with the insurance company, the patient and Prisma Health departments to find resolution to claim denials, making all necessary claim and account corrections to ensure the full reimbursement of services rendered
Escalates accounts both at the payer and/or internally when appropriate, as well as involving the patient appropriately in accordance with the Prisma Health escalation guidelines in order to keep AR aging at acceptable levels for payer issues
Identify system issues through trending and repetitive actions that require workflow review or changes to resolve compliant billing
Utilize proper tools to communicate with Prisma Health department teams on specific errors for corrections related to their area of responsibility
Contacts insurance payers, patients or guarantors at established intervals to follow-up on status of delinquent accounts, determines the reason of delay and expedites payment
Must meet daily performance productivity and quality goals. Is attentive to detail and accuracy, is committed to excellence, looks for improvements continuously, monitors quality levels, finds root cause of quality problems and owns/acts on quality problems. Actively contributes to department goals. Effectively utilizes time and resources, assisting co-workers as time allows. Must be dependable
Maintains professional growth and development through seminars, workshops, in-service meetings, current literature and professional affiliations to keep abreast of latest trends in field of expertise
All policies and procedures will be strictly adhered to. HIPAA, security, dress code, etc. will be conscientiously followed. Understands, promotes and adheres to all matters of compliance with laws and regulations. High level demonstration of the Standards of Behaviors
Communicates well both verbally and in writing, shares information with others & has good listening skills
Performs other duties as assigned
Qualification
Required
High School diploma or equivalent OR post-high school diploma/highest degree earned
3 years - hospital claims and billing follow-up; understanding of the hospital and physician claim forms, knowledge of payer guidelines
Preferred
Bachelor's degree and 2 years of hospital billing, follow-up/denials
CRCA or CRCR - preferred
Communication skills and respect for details - preferred
Company
Prisma Health
Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
CDA Foundation
2024-07-30Grant
Leadership Team
Mark O'Halla
President & CEO
B
Barrett Ludley
Facility Chief Financial Officer
Recent News
2026-01-16
Precedence Research
2025-09-09
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