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Patient Financial Analyst
2 months ago
Job Overview
The Patient Financial Analyst embodies the mission, vision, and values of Northwestern Memorial Healthcare, adhering to the organization's Code of Ethics and Corporate Compliance Program while complying with all relevant policies, procedures, guidelines, and regulatory standards.
Key Responsibilities:
- Consistently achieve the established productivity and quality benchmarks in the prompt resolution of claim edits, ensuring timely submission of compliant claims and meeting clinical documentation requirements.
- Meet or surpass productivity targets, error ratios, and reporting obligations as designated by the Patient Accounting Lead Financial Analyst and Operations Coordinator.
- Conduct timely follow-up and collection of third-party payer receivables.
- Manage denials and appeals through root cause analysis to mitigate future denials while striving for payment resolution.
- Maintain compliant follow-up communication with third-party payers regarding outstanding accounts receivables.
- Support operations related to optimal third-party accounts receivables, including Managed Care, Commercial, Medicare, Medicaid, and other specialty accounts.
- Perform daily reviews of work lists to ensure all accounts are addressed promptly.
- Utilize governmental, commercial, and regulatory guidelines for the collection of outstanding accounts, recommending accounts for write-off with appropriate justification.
- Adhere to HIPAA privacy standards and ensure compliance with patient health information practices.
- Contribute to the overall team effort in achieving departmental accounts receivable goals.
- Identify opportunities for customer, system, and process enhancements and communicate these to management.
- Follow all general and departmental policies and procedures, including those mandated by regulatory agencies.
- Engage in testing for assigned software applications, ensuring field integrity.
- Assist the Patient Accounting Operational Coordinator and Team Lead Financial Analyst with special projects and other assigned duties.
- Participate in training and seminars as directed by the Patient Accounting Operations Coordinator.
Additional Responsibilities:
- Exhibit exceptional customer service through effective oral and written communication, providing assistance to patients and authorized guarantors.
- Demonstrate proficient use of systems and execution of processes across all responsibilities.
- Possess a working knowledge of physician and facility billing, including an understanding of insurance regulations, particularly Medicare and Medicaid.
- Maintain knowledge of HIPAA standards.
- Exhibit strong mathematical calculation skills.
- Demonstrate excellent communication abilities when interacting with patients, families, and professional offices.
- Have a basic understanding of medical terminology and billing practices.
