Patient Financial Services, Associate - Insurance

POSITION SUMMARY:

Under the direction of the PFS Team Lead and/or PFS Assistant Director, the Patient Financial Services (PFS) Associate is responsible for the accurate and timely review, billing, follow‑up, and resolution of assigned third‑party and/or patient accounts. This includes high‑dollar and complex service claims, ensuring that responsible payers are billed correctly and that payment is secured in accordance with payer requirements and organizational standards.

JOB DUTIES & ESSENTIAL FUNCTIONS:

The PFS Associate actively manages account activity throughout the revenue cycle by performing account analysis, follow‑up, and resolution, and by documenting all claim statuses, actions taken, and outcomes clearly and accurately within the patient accounting systems. The role requires independent judgment to identify billing errors, underpayments, and claim delays, and to take appropriate corrective action to promote clean claim resolution and timely reimbursement.

The PFS Associate ensures a high level of customer satisfaction by providing timely, accurate, and professional responses to patient inquiries, requests for information, and claim appeals. This includes explaining account balances, insurance determinations, and billing outcomes in a clear and compassionate manner, while adhering to privacy, compliance, and customer service standards.

In addition, the PFS Associate is responsible for identifying and analyzing complex claim issues, denial patterns, payment variances, and payer trends, and for communicating findings to leadership. The Associate escalates unresolved or high‑risk issues as appropriate and contributes recommendations to improve billing accuracy, workflow efficiency, and overall revenue cycle performance.

This role requires a working knowledge of payer regulations, billing processes, and revenue cycle workflows, and plays a critical role in safeguarding hospital reimbursement and financial integrity.

REQUIRED EXPERIENCE AND QUALIFICATIONS:

• High School diploma or equivalent.
• Must have 3+ years prior healthcare billing experience and knowledge of medical terminology.
• Knowledge of Word and Excel applications.
• Must be able to adapt to system changes, manage heavy call volume, be a self-starter, organized, detail oriented.

PREFERRED EXPERIENCE AND QUALIFICATIONS:

• College degree and or certifications in billing and coding.
• Bilingual.

PHYSICAL DEMANDS:

• Lift stored document boxes up to 10 lbs.

As part of employment at Southampton Hospital, there may be occasions when travel to other locations is needed to support operational needs.

Special Notes: Resume/CV should be included with the online application.

• Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
• All Hospital positions may be subject to changes in pass days and shifts as necessary.
• This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
• This function/position maybe designated as “essential.” This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.

Anticipated Pay Range:

The starting salary range (or hiring range) for this position has been established based on relevant experience.

The above salary range (or hiring range) represents SBSH’s good faith and reasonable estimate of the range of possible compensation at the time of posting.

Your total compensation goes beyond the number in your paycheck!

Prior to start date, the selected candidate must meet the following requirements:

Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Southampton Hospital’s Employee Health Services*

• Complete electronic reference check with a minimum of three (3) professional references.
• Successfully complete a 4 panel drug screen*