Job Description

PFS GROUP, one of the fastest growing national healthcare outsourcing companies, is seeking Insurance Representatives to provide regular communication with insurance companies to ensure timely resolution of account balances and patient’s eligibility for date of service. It also involves placing outgoing calls and receiving incoming calls to facilitate collection and resolution of insurance accounts.

PFS GROUP is focused on helping our client partners resolve healthcare accounts receivable better and faster than our competition. Our experience and success, combined with a strategic sense of urgency, provide unparalleled results for our prestigious clients.

Would you like to be a part of one of the fastest growing national healthcare outsourcing companies? One that is experiencing steady growth while providing superior service to our clients?

Under the supervision of the Insurance Department Supervisor, ensures the efficient operation and effective reimbursement of third party account receivables by researching accounts, refiling or appealing claims, submitting additional medical documentation and tracking account status by monitoring and analyzing assigned unresolved third party accounts. This position initiates contacts and negotiates appropriate resolution (internal and external) as well as receives and resolves inquiries and correspondence from third parties and patients. The ability to analyze, audit and reconcile an account is critical to this position. Processes in the claims resolution may vary based on clients’ needs and/or contract. This position follows-up on aged accounts receivable to help ensure continuity of cash flow and to help secure resolution of account balances.

REQUIREMENTS

• Medical insurance and/or medical collections experience
• Ability to analyze, audit and reconcile accounts
• Knowledgeable in all aspects of insurance reimbursement
• Knowledge of government, commercial, worker’s comp and managed care reimbursement guidelines
• Familiarity with all federal, state and local legal aspects of collection activities
• Outstanding listening, communication, problem-solving and research skills
• Good Microsoft Outlook, Excel, and Word skills
• Strong customer service experience demonstrating compassion and concern
• Able to communicate effectively both oral and written and good interpersonal skills
• Ability to work well under pressure and multi-task routinely
• Professional presentation/appearance/demeanor
• Demonstrated stable work history
• HIPAA knowledge

PREFERENCES

• Medi-Cal and California Children’s Services (CCS)
• Knowledge of Medicare and Medicaid regulations and other insurance guidelines preferred
• EPIC experience
• Familiar with Waystar
• Experience using CUBS computer system
• Non-smoker

ALL CANDIDATES WILL UNDERGO A NATIONAL BACKGROUND CHECK AND DRUG SCREENING.

Company Description

PFS Group Nationwide Patient Account Management Firm. Based in Houston, Texas, with satellite offices in Texas, California and North Carolina, we currently work with 25+ clients who operate more than 100 hospital facilities from small, rural community medical centers to metro population center health systems. Leaders in their respective markets and nationwide, our clients rely on our services to support their accounts receivable departments. Our commitment to the healthcare industry is also demonstrated through our sponsored and encouraged certification achievements, as well as participation in AAHAM and/or HFMA. PFS Group offers a friendly, caring work environment, competitive benefits and compensation, (ZayZoon option available!) medical, dental, vision, short and long-term disability, life insurance, Hospital Indemnity, Critical Illness, Accident Insurance, MDLive, a matching 401(k) with profit-sharing, etc. Teamwork, Dependability, Self-Motivation and the highest level of professional conduct are an integral part of all positions with PFS Group!