Patient Financial Specialist

The Patient Financial Specialist supports the Revenue Cycle division by driving timely account resolution and accurate reconciliation of outstanding patient balances.

Responsibilities

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Performs Revenue Cycle activities to meet or exceed CHRISTUS Health key performance metrics.
• Ensures departmental PFS quality and productivity standards are met.
• Collects and provides patient and payor information to facilitate account resolution.
• Maintains current working knowledge of Government Mandated Regulations for claim submission, including researching proper governmental requirements prior to submission.
• Responds to account inquiries via written, verbal, or electronic communication.
• Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines for third-party payers.
• Maintains working knowledge of all functions within the Revenue Cycle.
• Provides professional, effective communication to internal and external customers to resolve outstanding account questions.
• Maintains compliance with CHRISTUS Health, payer, and government regulations.
• Applies knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
• Documents patient accounting activity in the patient accounting host system or other PFS systems per policy and procedures.
• Provides continuous updates to the PFS Leadership Team on errors, issues, and trends impacting productivity, reimbursement, payment delays, and/or patient experience.
• Reviews and works claim edits.
• Works payor rejected claims for resubmission.
• Works reports and billing requests, applying strong knowledge of bill forms and filing requirements.
• Demonstrates understanding of electronic claims editing and submission capabilities.
• Corrects claims in RTP status in the designated claim system per Medicare guidelines.
• Stays current on governmental agency requirements and updates.
• Collects balances due from payors to ensure proper reimbursement for services.
• Identifies and forwards proper account denial information to the designated departmental liaison to support denial resolution and timely turnaround.
• Works the collector queue daily using appropriate collection systems and reports.
• Identifies and resolves underpayments and credit balances using follow-up activities within payor timely guidelines.
• Identifies and communicates trends impacting account resolution.
• Initiates Medicare Redetermination, Reopening and/or Reconsideration as needed.
• Maintains working knowledge of the CMS 838 credit balance report.
• Serves as a liaison between external vendors and Revenue Cycle departments, monitoring vendor activity and ensuring accounts placed for collection are received and acknowledged.
• Manages account transfers between CHRISTUS Health and contracted vendors.
• Coordinates with Revenue Cycle Managers (Collections, Billing, Cash Applications, etc.) to review selected accounts prior to transfer and placement with an external third party.
• Ensures vendor-closed or uncollectible accounts are properly reflected in applicable AR systems.
• Maintains department reports measuring agency performance, including placements, collections, returns, and performance metrics.
• Advises vendors on CHRISTUS Health billing and collection procedures and ensures third-party coverage accounts are billed as requested by the vendor.
• Audits vendor remittances and verifies fees billed to CHRISTUS Health align with the contract and include supporting documentation for payments posted to patient accounting systems.
• Recalls incorrectly placed accounts as requested by Revenue Cycle Managers and returns accounts to open receivables when appropriate.
• Creates tools, reports, or documentation to help Revenue Cycle Leadership understand, manage, and measure vendor performance and prioritize relationships.
• Performs account reconciliation between the CHRISTUS Health system and vendor system.

Requirements

• HS Diploma or equivalent experience required.
• Post-HS education preferred.
• 1-3 years of experience preferred.
• Experience in 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 with UB-04 and HCFA 1500 inpatient and outpatient billing requirements preferred.
• Experience with Medicare & Medicaid billing processes and regulations preferred.
• Understanding of Medicare language preferred.
• Knowledge locating and referencing CMS and/or Medicare regulations preferred.
• None required.

Schedule

• 5 Days - 8 Hours

Work Type

• Full Time