Patient Financial Specialist Senior - Patient Financial Services

Description

The associate is responsible for the duties and services that are of a support nature to the Revenue Cycle division of CHRISTUS Health. The associate ensures that all processes are performed in a timely and efficient manner. The primary purpose of this job is to ensure account resolution and reconciliation of outstanding balances for CHRISTUS Health patient accounts. The job works in a cooperative team environment to provide value to internal and external customers.

The associate must demonstrate a consistently high degree of proficiency in their primary position within the Patient Financial Services Department of CHRISTUS Health. The associate is responsible for a variety of activities in the department while applying one s expertise and knowledge within the unit. The job provides opportunities to increase one s scope of responsibility within the PFS Department.

Working in partnership with the management team serves as a resource for innovation, staff support, and process improvements. The associate carries out his/her duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of CHRISTUS Health, and fully supports CHRISTUS Health s 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 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, and 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 that affect reimbursement resulting in payment delays and/or loss of 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 advanced 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.
• ARSU Team
• Works reports and requests from facility or other revenue cycle areas to identify and communicate trends impacting account resolution.
• Works and completes assigned 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. Dedicated 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…