PFS Team Lead

Inova Center of Personalized Health is looking for a dedicated Patient Financial Services Team Lead to join the team Insurance Follow Up team. This role will be full-time day shift from Monday - Friday, 8:00 a.m. - 5:00 p.m.

The Patient Financial Services (PFS) Team Lead is responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims. Processes claims for at least one payer type (e.g. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.). Ensures that all assigned claims meet clearinghouse and/or payer processing criteria. Provides appropriate follow-up on assigned work lists while ensuring that all work meets departmental productivity and quality review standards. Performs duties, as assigned, in the absence of the supervisor or manager.

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 Team Lead Job Responsibilities:

• Submits all clean claims the day they are received via the appropriate medium and with all required attachments.
• Ensures that claims are reviewed, corrections identified/made or resolution initiated within 24 hours from the date claims are received.
• Handles complex and/or highest dollar accounts and provides appropriate follow-up based on established protocol.
• In accordance with departmental quality review standards, ensures that documentation is professional, appropriate, and accurately depicts actions performed. Identifies issues with payer rejections and provides feedback regarding rejections to management.
• Initiates resolution to issues and/or seeks/takes direction from management to resolve issues as appropriate.
• Maintains knowledge of payer requirements, UB-92 standards, system (e.g. Hospital, clearinghouse, payer) functionality, and hospital policies and procedures. Serves in a supervisory role, as needed, in the absence of the supervisor and/or manager.
• Ensures that all daily, weekly, and monthly reports are complete and submitted timely, at least 80 percent of the time, and with minimal errors. Documents and reports claim submission issues immediately and provides feedback to management regarding issues/wins.
• Provides resolution for pending (WIP backlog) claims within allowable timeframes. Resolves complex issues either through individual actions or by coordinating information/actions of other team members, other Patient Accounts staff, or the appropriate individuals in other departments.
• Oversees and assists team members in assigned functional area, which may include but not limited to, ensuring team is meeting key-deliverables and quality standards, addressing and resolving challenges, managing and tracking performance, and assisting in time management and scheduling; escalates issues to senior leaders as needed.

Patient Financial Services Team Lead Requirements:

• Work Schedule: 8-hour shift (Monday - Friday days, 8:00 a.m. - 5:00 p.m.) ; Hybrid
• Education: High School or GED
• Experience: Three years of experience in cash entry, Electronic Remittance Advice (ERA) retrieval/posting, cash posting, banking lockbox support, revenue cycle, finance, customer service, data analytics or refund/credit balance review.

Patient Financial Services Team Lead Preferred Requirements:

• Experience with insurance follow up is highly preferred
• Strong understanding of healthcare revenue cycle and payer reimbursement methodologies.
• Experience with remittance research and the EPIC system.
• Proficient in using payer portals and handling ERA/EOB reconciliation.
• Proven leadership experience in a healthcare setting, with a focus on team development and performance management.
• Ability to analyze payment discrepancies, resolve issues, and communicate effectively with both internal and external stakeholders.
• Excellent organizational, communication, and problem-solving skills.