Patient Financial Specialist - Financial Services

Description

Summary :

The associate is responsible for the duties and servicesthat are of a support nature to the Revenue Cycle division ofCHRISTUS Health.

The associate ensures that all processes areperformed in a timely and efficient manner. The primary purpose ofthese positions is to ensure account resolution and reconciliationof outstanding balances for CHRISTUS Health patient accounts.

Theposition works in a cooperative team environment to provide valueto internal and external customers.

The associatecarries out his / her duties by adhering to the highest standards ofethical and moral conduct, acts in the best interest of CHRISTUSHealth, and fully supports CHRISTUS Health's Mission, Philosophy,and core values of Dignity, Integrity, Compassion, Excellence andStewardship.

Responsibilities :

• Meets expectations of the applicable OneCHRISTUSCompetencies : Leader of Self, Leader of Others, or Leader ofLeaders.
• Performs Revenue Cycle functions in a mannerthat meets or exceeds CHRISTUS Health's key performance metrics.
• Ensures PFS departmental quality and productivitystandards are met.
• Collects and provides patient andpayor information to facilitate account resolution.
• Maintains an active working knowledge of all Government MandatedRegulations as it pertains to claims submission. Responsible toperform the necessary research in order to determine propergovernmental requirements prior to claims submission.
• Responds to all types of account inquires through written, verbal,or electronic correspondence.
• Maintainspayor-specific knowledge of insurance and self-pay billing andfollow-up guidelines and regulations for third-party payers.

Maintains working knowledge of all functions within the RevenueCycle.

• Responsible for professional and effectivewritten and verbal communication with both internal and externalcustomers in order to resolve outstanding questions for accountresolution.
• Meets or exceeds customer expectationsand requirements, and gains customer trust and respect.
• Compliant with all CHRISTUS Health, payer, and governmentregulations.
• Exhibits a strong working knowledge ofCPT, HCPCS, and ICD-10 coding regulations and guidelines.
• Appropriately documents patient accounting host system orother systems utilized by PFS in accordance with policy andprocedures.
• Provide continuous updates andinformation to the 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 communicationrequired.

Billing

• Review andwork on claim edits.
• Works payor rejected claims forresubmission.
• Works reports and billing requests.
• Demonstrates strong knowledge of standard bill formsand filing requirements.
• Exhibits and understandingof electronic claims editing and submission capabilities.
• Correct claims in RTP status in the designated claim systemper Medicare guidelines.
• Maintains an activeknowledge of all governmental agency requirements andupdates.

Collections

• Collectbalances due from payors ensuring proper reimbursement for allservices.
• Identifies and forwards proper accountdenial information to the designated departmental liaison.Dedicated efforts to ensure a proper denial resolution and timelyturnaround.
• Maintain an active knowledge of allgovernmental agency requirements and updates.
• Workscollector queue daily utilizing appropriate collection system andreports.
• Demonstrates knowledge of standard billforms and filing requirements.
• Identify and resolveunderpayments with the appropriate follow-up activities withinpayor timely guidelines.
• Identify and resolve creditbalances with the appropriate follow-up activities within payortimely guidelines.
• Identify and communicate trendsimpacting account resolution.
• Corrects claims in RTPstatus in the designated claim system per Medicareguidelines.
• Initiates Medicare Redetermination,Reopening and / or Reconsideration as needed.
• Workingknowledge of the CMS 838 credit balance report.

Vendor Coordinator

• Acts as liaison betweenexternal vendors and Revenue Cycle departments to monitor externalvendor activities and ensures accounts placed for collection arereceived timely and acknowledged as received by the vendor.
• Manages account transfers between CHRISTUS Health and thevarious contracted vendors.
• Coordinates with RevenueCycle Managers (Collections, Billing, Cash Applications, etc.) toreview of selected accounts prior to transfer and placement with anexternal third party.
• Ensures accounts deemed asclosed or uncollectible by the vendors are properly reflected inapplicable AR systems.
• Maintains department reportsmeasuring agency performance, which includes account placements,collections, returns, and performance metrics.
• Advises vendors of CHRISTUS Health billing and collectionprocedures and ensures accounts identified with third-partycoverage are properly billed by the entities as requested by thevendor.
• Audits all vendor remittances and ensures allfees billed to CHRISTUS Health are in accordance with the contractand include supporting documentation of payments posted to theaccount on the patient accounting systems.
• Recallsaccounts incorrectly placed and / or as requested by Revenue CycleManagers with the external vendor and returns accounts to openreceivables as appropriate.
• Creates tools, reports,or documentation that enables Revenue Cycle Leadership tounderstand, manage, and measure their vendor's performance and toprioritize important relationships.
• Performs accountreconciliation between CHRISTUS Health system and vendorsystem.

Requirements :

• HS Diploma or equivalent years of experiencerequired.
• Post HS educationpreferred.
• 1-3 years of experiencepreferred.
• Experience working within amulti-facility hospital business office environmentpreferred.
• College education, previousInsurance Company claims experience, and / or health care billingtrade school education may be considered in lieu of formal hospitalexperience.
• Experience working withinpatient and outpatient billing requirements of UB-04 and HCFA1500 billing forms preferred.
• Experiencewith Medicare & Medicaid billing processes and regulationspreferred.
• Understanding of Medicarelanguage.
• Knowledge in locating andreferencing CMS and / or Medicare Regulationspreferred.

Work Schedule : Work Type :

Work Type : Full Time

Full Time

EEO is the law -click below for more information :

https : / / www.eeoc.gov / sites / default / files / 2023-06 / 22-088 EEOC KnowYourRights6.12ScreenRdr.pdf

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