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 performancemetrics.
• Ensures PFS departmental quality andproductivity standards are met.
• Collects and providespatient and payor information to facilitate accountresolution.
• Maintains an active working knowledge ofall Government Mandated Regulations as it pertains to claimssubmission. Responsible to perform the necessary research in orderto determine proper governmental requirements prior to claimssubmission.
• Responds to all types of account inquiresthrough written, verbal, or electronic correspondence.
• Maintains payor-specific knowledge of insurance and self-paybilling and follow-up guidelines and regulations for third-partypayers.

Maintains working knowledge of all functions within theRevenue Cycle.

• Responsible for professional andeffective written and verbal communication with both internal andexternal customers in order to resolve outstanding questions foraccount resolution.
• Meets or exceeds customerexpectations and requirements, and gains customer trust andrespect.
• Compliant with all CHRISTUS Health, payer,and government regulations.
• Exhibits a strong workingknowledge of CPT, HCPCS, and ICD-10 coding regulations andguidelines.
• Appropriately documents patientaccounting host system or other systems utilized by PFS inaccordance with policy and procedures.
• Providecontinuous updates and information to the PFS Leadership Teamregarding errors, issues, and trends related to activitiesaffecting productivity, reimbursement, payment delays, and / orpatient experience.
• Professional and effectivewritten and verbal communication required.

Billing

• Review and work on claim edits.
• Works payor rejected claims for resubmission.
• Worksreports and billing requests.
• Demonstrates strongknowledge of standard bill forms and filing requirements.
• Exhibits and understanding of electronic claims editing andsubmission capabilities.
• Correct claims in RTP statusin the designated claim system per Medicare guidelines.
• Maintains an active knowledge of all governmental agencyrequirements and updates.

Collections

• Collect balances due from payors ensuring properreimbursement for all services.
• Identifies andforwards proper account denial information to the designateddepartmental liaison. Dedicated efforts to ensure a proper denialresolution and timely turnaround.
• Maintain an activeknowledge of all governmental agency requirements andupdates.
• Works collector queue daily utilizingappropriate collection system and reports.
• Demonstrates knowledge of standard bill forms and filingrequirements.
• Identify and resolve underpayments withthe appropriate follow-up activities within payor timelyguidelines.
• Identify and resolve credit balances withthe appropriate follow-up activities within payor timelyguidelines.
• Identify and communicate trends impactingaccount resolution.
• Corrects claims in RTP status inthe designated claim system per Medicare guidelines.
• Initiates Medicare Redetermination, Reopening and / orReconsideration as needed.
• Working knowledge of theCMS 838 credit balance report.

VendorCoordinator

• Acts as liaison between external vendorsand Revenue Cycle departments to monitor external vendor activitiesand ensures accounts placed for collection are received timely andacknowledged as received by the vendor.
• Managesaccount transfers between CHRISTUS Health and the variouscontracted vendors.
• Coordinates with Revenue CycleManagers (Collections, Billing, Cash Applications, etc.) to reviewof 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.

JobRequirements :

• HSDiploma 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.

WorkSchedule : WorkType :

WorkType : FullTime

FullTime

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