Patient Financial Specialist
3 days ago
The Patient Financial Specialist plays a critical role in the Revenue Cycle division of CHRISTUS Health, ensuring timely and efficient processing of patient accounts. This position is responsible for account resolution and reconciliation of outstanding balances, working in a cooperative team environment to provide value to internal and external customers.
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 inquires 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.
- Meets or exceeds customer expectations and requirements, and gains customer trust and respect.
- Compliant with all CHRISTUS Health, payer and government regulations.
- Exhibits a strong working knowledge of CPT, HCPCS and ICD-10 coding regulations and guidelines.
- Appropriately documents patient accounting host system or other systems utilized by PFS in accordance with policy and procedures.
- Provides 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.
- Review and work claim edits.
- Works payor rejected claims for resubmission.
- Works reports and billing requests.
- Demonstrates strong knowledge of standard bill forms and filing requirements.
- Exhibits and understanding of electronic claims editing and submission capabilities.
- Correct claims in RTP status in designated claim system per Medicare guidelines.
- Collect balances due from payors ensuring proper reimbursement for all services.
- Identifies and forwards proper account denial information to the designated departmental liaison.
- Maintain an active knowledge of all governmental agency requirements and updates.
- Works collector queue daily utilizing appropriate collection system and reports.
- Demonstrates 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.
- Corrects claims in RTP status in designated claim system per Medicare guidelines.
- Initiates Medicare Redetermination, Reopening and/or Reconsideration as needed.
- Working knowledge of the CMS 838 credit balance report.
- Acts 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.
- Manages account transfers between CHRISTUS Health and the various contracted vendors.
- Coordinates with Revenue Cycle Managers (Collections, Billing, Cash Applications, etc.) to review of selected accounts prior to transfer and placement with an external third party.
- Ensures accounts deemed as closed or uncollectible by the vendors are properly reflected in applicable AR systems.
- Maintains department reports measuring agency performance, which includes account placements, collections, returns and performance metrics.
- Advises 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.
- Audits 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.
- Recalls accounts incorrectly placed and/or as requested by Revenue Cycle Managers with the external vendor and returns accounts to open receivables as appropriate.
- Creates tools, reports or documentation that enables Revenue Cycle Leadership to understand, manage and measure their vendor's performance and to prioritize important relationships.
- Performs account reconciliation between CHRISTUS Health system and vendor system.
- 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
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