PFS Coordinator

Skills and Abilities Required

Demonstrated knowledge of medical terminology, insurance terminology, and revenue cycle operations.
Proficient in claims billing, appeals, denials management, collections, and payer audits.
Strong understanding of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC), including the ability to evaluate, research, and resolve denial-related issues.
Demonstrated critical thinking and analytical skills with the ability to identify barriers within the claims lifecycle and develop effective solutions to achieve claim resolution.
Ability to independently investigate and resolve complex billing and reimbursement issues.
Strong written and verbal communication skills, including the ability to effectively communicate with payers, providers, leadership, and internal stakeholders.
Preferred experience with both inpatient and outpatient hospital billing and reimbursement processes.

Education and Experience Required

Experience educating clinical providers on documentation requirements, CPT coding, ICD-10 coding, medical necessity requirements, and revenue cycle best practices.
Experience reviewing clinical documentation and progress notes to ensure alignment with billing, coding, and reimbursement requirements.
Demonstrated experience managing high-dollar accounts and complex claim resolution.
Strong appeal-writing skills, including the ability to prepare persuasive and well-supported appeals to insurance carriers.
Ability to work independently with minimal supervision while effectively prioritizing workload and meeting departmental expectations.

Areas of Responsibility

The PFS Coordinator is expected to independently manage and resolve issues related to:

Past Due Claims
Technical Denials
At-Risk Claims
Referrals and Authorization Issues
Accounts Receivable Follow-Up
Payer Correspondence and Appeals
Revenue Recovery Opportunities

The PFS Coordinator is expected to demonstrate ownership of assigned accounts through timely follow-up, proactive problem-solving, appropriate escalation of issues, and adherence to departmental productivity and quality standards.