Patient Financial Specialist - Patient Financial Services

Overview

The associate is responsible for duties and services that support the Revenue Cycle division of CHRISTUS Health. The associate ensures that all processes are performed in a timely and efficient manner to resolve and reconcile outstanding balances for CHRISTUS Health patient accounts. The role works in a cooperative team environment to provide value to internal and external customers. The associate adheres to the highest standards of ethical conduct and supports CHRISTUS Health's Mission, Philosophy, and core values of Dignity, Integrity, Compassion, Excellence and Stewardship.

• 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 s key performance metrics.
• Ensures PFS departmental quality and productivity standards are met.
• Collects and provides patient and payor information to facilitate account resolution.
• Maintains an active working knowledge of Government Mandated Regulations as it pertains to claims submission and performs the necessary research to determine proper governmental requirements prior to claims submission.
• Responds to all types of account inquiries through written, verbal, or electronic correspondence.
• Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers; maintains working knowledge of all functions within the Revenue Cycle.
• Communicates professionally and effectively with internal and external customers 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.
• Documents patient accounting host system or other systems utilized by PFS in accordance with policy and procedures.
• Provides continuous updates and information to the PFS Leadership Team regarding errors, issues, and trends related to productivity, reimbursement, payment delays, and/or patient experience.
• Demonstrates professional written and verbal communication.
• Billing: review and work on claim edits; work payor rejected claims for resubmission; work reports and billing requests; demonstrate knowledge of standard bill forms and filing requirements; understand electronic claims editing and submission capabilities; correct claims in RTP status per Medicare guidelines; maintain knowledge of governmental agency requirements and updates.
• Collections: collect balances due from payors ensuring proper reimbursement; identify and forward proper denial information to the designated departmental liaison with dedicated denial resolution and timely turnaround; work collector queue daily; identify and resolve underpayments and credit balances within payor timely guidelines; identify and communicate trends impacting account resolution; corrects claims in RTP status per Medicare guidelines; initiate Medicare Redetermination, Reopening and/or Reconsideration as needed;
  
  maintain CMS 838 credit balance report knowledge.
• Vendor Coordinator: act as liaison between external vendors and Revenue Cycle departments to monitor external vendor activities and ensure accounts placed for collection are received timely and acknowledged; manage account transfers; coordinate with Revenue Cycle Managers to review selected accounts prior to transfer; ensure closed or uncollectible accounts are properly reflected in AR systems; maintain department reports measuring agency performance; advise vendors of CHRISTUS Health procedures;
  
  audit vendor remittances; recalls and returns accounts to open receivables as appropriate; create tools/reports to understand vendor performance.
• Performs account reconciliation between CHRISTUS Health system and vendor systems.

• HS Diploma or equivalent years of experience required. Post HS education preferred.

• 1-3 years of experience preferred.
• Experience in a multi-facility hospital business office environment preferred.
• College education, prior Insurance Company claims experience, and/or health care billing trade school education may be considered in lieu of formal hospital experience.
• Experience with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 forms preferred.
• Experience with Medicare & Medicaid billing processes and regulations preferred.
• Understanding of Medicare language and CMS/Medicare Regulations preferred.

• None required.

5 Days - 8 Hours

Full Time