Patient financial specialist

Job Description

Summary :

The associate carries out his / her duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of CHRISTUS Health and fully supports CHRISTUS Health's core values of Dignity, Integrity, Compassion, Excellence and Stewardship.

Responsibilities :

• Meets expectations of the applicable OneCHRISTUS Competencies : Leader of Self, Leader of Others, or Leader of Leaders.
• Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health key performance metrics.
• Ensures PFS departmental quality and productivity standards are met.
• Functions as a subject matter expert in support of other PFS team members and other departments / facilities within the CHRISTUS Health network.
• Demonstrates a good understanding and has the ability to interact with the payer to verify coverage, submit claims, follow up on appeals, underpayments, short pays or payment disputes for resolution.
• Investigate and resolve complex payment denials inclusive of correcting errors and supplying additional required information to facilitate collection of reimbursement / additional reimbursement.
• Ability to analyze, recognize, and resolve issues utilizing strategic thinking.
• Level of knowledge and the ability to work with a variety of payers.
• Adapt to process and procedure evaluations and improvements, support continuous change, and willingly manage special projects in addition to normal workload and other duties as assigned.
• Responsible for professional and effective written and verbal communication with both internal and external customers.
• 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 strategic business analysis updates and information to PFS Leaders and System Director regarding operational opportunities affect reimbursement resulting in payment delays and / or loss revenue.
• Must have in-depth knowledge and ability to maneuver efficiently through Patient Accounting Systems, Document Imaging, Databases, etc.

Strong understanding of systems from an end-user and processing perspective.

• Must have understanding of Medicare and Commercial contract language.
• Must have good technical aptitude working with a variety of MS Office products (Word, Excel, PowerPoint, Outlook) and / or ability to learn and develop more advance skills with the various applications.
• Must have strong verbal and written communication skills. Ability to effectively and efficiently articulate ideas to team members and management in a timely manner.
• General hospital A / R accounts knowledge is required.

ARSU Team

• Works reports and requests from facility or other revenue cycle areas to identify and communicate trends impacting account resolution.
• Works and completes assigned collection insurance collection work queues on a daily basis which will include technical denials and at-risk claims.
• Reviews accounts to check for qualification for combining according to both government and non-government payer rules and regulations and combines accounts as required to maintain compliance.
• Identify, address and communicate operational and financial risks.
• Resolve aged and / or problematic accounts.
• Utilize multiple reporting systems.
• Collect balances due from payors ensuring proper reimbursement for all services.
• Identifies and forwards proper account denial information to the designated departmental liaison. Dedicates efforts to ensure a proper denial resolution and timely turnaround.
• 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 and credit balances with the appropriate follow up activities within payor timely guidelines.
• Initiates Medicare Redetermination, Reopening and / or Reconsideration as needed.

Billing Audit

• Works reports and requests from facility or other revenue cycle areas.
• Reviews accounts to check for qualification for combining according to both government and non-government payer rules and regulations and combines accounts as required to maintain compliance.
• Works unbilled and failed claim reports to resolve claim checks in Patient Accounting host system.
• Demonstrates strong knowledge of standard bill forms and filing requirements.
• Exhibits and understanding of electronic claims editing and submission capabilities.
• Identify and communicate trends impacting account resolution. Maintains an active working knowledge and ability to perform necessary research of Government and Non-Government Regulations as it pertains to claims submission.

Requirements :

• HS Diploma or equivalent years of experience required
• Post HS education preferred
• 3-5 years of experience preferred
• Experience calculating expected reimbursement according to payer regulations and / or contracts required
• Experience with Commercial, Medicare, and Medicaid reimbursement.
• Medicare, Medicaid, VA, Tricare billing and collections processes and regulations 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.
• Prefer hands on experience with Medicare Remote (FISS) DDE.

Last updated : 2024-05-20