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Healthcare Financial Services Associate
2 months ago
Overview:
The Healthcare Financial Services Associate plays a crucial role in supporting the Revenue Cycle operations at CHRISTUS Health. This position is dedicated to ensuring timely and efficient processes that facilitate the resolution and reconciliation of outstanding patient account balances. Working collaboratively within a team, the associate aims to deliver exceptional service to both internal and external stakeholders.
The associate upholds the highest standards of ethical conduct, prioritizing the interests of CHRISTUS Health while embodying the organization's Mission, Philosophy, and core values of Dignity, Integrity, Compassion, Excellence, and Stewardship.
Key Responsibilities:
• Adheres to the OneCHRISTUS Competencies, fulfilling the role of a self-leader, leader of others, or leader of leaders.
• Executes Revenue Cycle tasks that meet or surpass CHRISTUS Health's performance benchmarks.
• Ensures that departmental quality and productivity standards are consistently achieved.
• Gathers and supplies patient and payer information to assist in account resolution.
• Maintains up-to-date knowledge of all Government Mandated Regulations related to claims submission, conducting necessary research to ensure compliance.
• Addresses various account inquiries through written, verbal, or electronic communication.
• Keeps informed about payer-specific insurance and self-pay billing guidelines and regulations for third-party payers, while maintaining a comprehensive understanding of all Revenue Cycle functions.
• Engages in professional and effective communication with both internal and external customers to resolve outstanding account questions.
• Strives to meet or exceed customer expectations, earning their trust and respect.
• Complies with all CHRISTUS Health, payer, and government regulations.
• Demonstrates a strong understanding of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
• Accurately documents activities in the patient accounting system in accordance with established policies and procedures.
• Provides ongoing updates to the PFS Leadership Team regarding errors, issues, and trends that may impact productivity, reimbursement, payment delays, or patient experience.
• Maintains professionalism in both written and verbal communication.
Billing Duties:
• Reviews and addresses claim edits.
• Processes payer-rejected claims for resubmission.
• Manages reports and billing requests.
• Exhibits a solid understanding of standard billing forms and filing requirements.
• Demonstrates knowledge of electronic claims editing and submission capabilities.
• Corrects claims in RTP status in the designated claim system per Medicare guidelines.
• Stays informed about all governmental agency requirements and updates.
Collections Responsibilities:
• Collects outstanding balances from payers, ensuring proper reimbursement for services rendered.
• Identifies and forwards appropriate account denial information to the designated departmental liaison, focusing on timely resolution.
• Maintains awareness of all governmental agency requirements and updates.
• Works daily on the collector queue utilizing the appropriate collection systems and reports.
• Demonstrates knowledge of standard billing forms and filing requirements.
• Identifies and resolves underpayments and credit balances with timely follow-up activities.
• Communicates trends affecting account resolution.
• Initiates Medicare Redetermination, Reopening, and/or Reconsideration as necessary.
• Possesses working knowledge of the CMS 838 credit balance report.
Vendor Coordination:
• Acts as a liaison between external vendors and Revenue Cycle departments, monitoring vendor activities and ensuring timely account placements for collection.
• Manages account transfers between CHRISTUS Health and contracted vendors.
• Collaborates with Revenue Cycle Managers to review selected accounts prior to transfer to external parties.
• Ensures that accounts deemed closed or uncollectible by vendors are accurately reflected in applicable AR systems.
• Maintains departmental reports that measure vendor performance, including account placements, collections, returns, and performance metrics.
• Advises vendors on CHRISTUS Health billing and collection procedures, ensuring proper billing for accounts with third-party coverage.
• Audits vendor remittances to ensure compliance with contractual agreements and documentation of payments.
• Recalls accounts placed incorrectly or as requested by Revenue Cycle Managers.
• Develops tools, reports, or documentation to help Revenue Cycle Leadership understand and manage vendor performance.
• Conducts account reconciliation between CHRISTUS Health systems and vendor systems.
Qualifications:
- High School Diploma or equivalent experience required.
- Post-secondary education preferred.
- 1-3 years of relevant experience preferred.
- Experience in a multi-facility hospital business office environment preferred.
- College education, previous insurance company claims experience, or health care billing trade school education may be considered in lieu of formal hospital experience.
- Familiarity with patient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred.
- Experience with Medicare and Medicaid billing processes and regulations preferred.
- Understanding of Medicare terminology.
- Knowledge of CMS and/or Medicare Regulations preferred.
Work Schedule:
TBD
Work Type:
Full Time
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