Patient Financial Specialist Senior - Financial Services
Christus Health
- Tyler, TX
- Permanent
- Full-time
- 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.
- Must have good understanding of the various areas of government, non-government programs, billing, customer service and cash applications.
- General hospital A/R accounts knowledge is required.
- 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.
- 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.
- 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.