Patient Financial Specialist
3 days ago
Job Summary:
The Patient Financial Specialist will be responsible for supporting the Revenue Cycle division of CHRISTUS Health. This role will ensure that all processes are performed in a timely and efficient manner, with a focus on account resolution and reconciliation of outstanding balances for CHRISTUS Health patient accounts.
Key Responsibilities:
- Meet expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- Perform Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health key performance metrics.
- Ensure PFS departmental quality and productivity standards are met.
- Collect and provide patient and payor information to facilitate account resolution.
- Maintain an active working knowledge of all Government Mandated Regulations as it pertains to claims submission.
- Respond to all types of account inquiries through written, verbal, or electronic correspondence.
- Maintain payor specific knowledge of insurance and self-pay billing and follow up guidelines and regulations for third-party payers.
- Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution.
- Meet or exceed customer expectations and requirements, and gain customer trust and respect.
- Compliant with all CHRISTUS Health, payer and government regulations.
- Exhibit a strong working knowledge of CPT, HCPCS and ICD-10 coding regulations and guidelines.
- Appropriately document patient accounting host system or other systems utilized by PFS in accordance with policy and procedures.
- Provide continuous updates and information to PFS Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement, payment delays, and/or patient experience.
- Professional and effective written and verbal communication required.
Account Resolution and Collections:
- Collect balances due from payors ensuring proper reimbursement for all services.
- Identify and forward proper account denial information to the designated departmental liaison. Dedicate efforts to ensure a proper denial resolution and timely turnaround.
- Maintain an active knowledge of all governmental agency requirements and updates.
- Work collector queue daily utilizing appropriate collection system and reports.
- Demonstrate knowledge of standard bill forms and filing requirements.
- Identify and resolve underpayments with the appropriate follow up activities within payor timely guidelines.
- Identify and resolve credit balances with the appropriate follow up activities within payor timely guidelines.
- Identify and communicate trends impacting account resolution.
- Correct claims in RTP status in designated claim system per Medicare guidelines.
- Initiate Medicare Redetermination, Reopening and/or Reconsideration as needed.
- Working knowledge of the CMS 838 credit balance report.
Vendor Coordination:
- Act as liaison between external vendors and Revenue Cycle departments to monitor external vendor activities and ensures accounts placed for collection are received timely and acknowledged as received by the vendor.
- Manage account transfers between CHRISTUS Health and the various contracted vendors.
- Coordinate with Revenue Cycle Managers (Collections, Billing, Cash Applications, etc.) to review of selected accounts prior to transfer and placement with an external third party.
- Ensure accounts deemed as closed or uncollectible by the vendors are properly reflected in applicable AR systems.
- Maintain department reports measuring agency performance, which includes account placements, collections, returns and performance metrics.
- Advise vendors of CHRISTUS Health billing and collection procedures and ensures accounts identified with third-party coverage are properly billed by the entities as requested by the vendor.
- Audit all vendor remittances and ensures all fees billed to CHRISTUS Health are in accordance with the contract and include supporting documentation of payments posted to the account on the patient accounting systems.
- Recall accounts incorrectly placed and/or as requested by Revenue Cycle Managers with the external vendor and return accounts to open receivables as appropriate.
- Create tools, reports or documentation that enables Revenue Cycle Leadership to understand, manage and measure their vendor's performance and to prioritize important relationships.
- Perform account reconciliation between CHRISTUS Health system and vendor system.
Requirements:
- HS Diploma or equivalent years of experience required
- Post HS education preferred
- 1-3 years of experience preferred
- Experience working within a multi-facility hospital business office environment preferred.
- College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
- Experience working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred.
- Experience with Medicare & Medicaid billing processes and regulations preferred.
- Understanding of Medicare language.
- Knowledge in locating and referencing CMS and/or Medicare Regulations preferred
Work Type:
Full Time
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