Patient Financial Services Lead

Job Overview

The Patient Financial Services (PFS) Lead serves as a liaison for the assigned teams and leadership, and functions as a level of leadership support for each team. Monitors staff productivity metrics and provides coaching as needed, provides training and schedules shadowing for all new hires during onboarding and afterward, and is the subject matter expert to support the team. Completes quality claim audits to help ensure staff are moving claims to payment.

Provides oversight on high dollar claims and oversees claim adjustments submitted by the team, approving or denying after claim review. Collaborates with payers' liaisons to verify processing and payment of claims, resolving aged accounts and escalating claim denials to maximize cash collections. Possesses a higher-level skillset of up-to-date knowledge of payer claim processing rules, reimbursement policies and regulations.

Department Name:
Patient Financial Services
Job Status:
Full time, 40 hours per week
Shift: Days, Hybrid

• Provides training of all tasks and workflows to all employees on assigned team, including new hires.
• Handles escalated payer and patient calls and proficiently discusses accounts, records, and services with patients/families. Maintains PFS e‑mail box and is the liaison to other departments within CHCO.
• Recognizes deviations from contractual expectation and payor activities/decisions, recognizes gaps in payment/reasoning or system errors. Corrects rejected, incomplete, and/or errored claims in Epic and Fin Thrive.
• Responsible for trending and analysis - identifying root cause with solution‑oriented mindset. Identifies and prioritizes accounts and work queues, based on type, payor, dollar, etc. Identifies trends within payers and escalates as necessary to payers, managed care, or government affairs.
• Responsible for QA and productivity measures to ensure timely feedback and resolution of escalated accounts. Assigns work assignments to the team.
• Reviews team adjustment requests for approval or denial, coaching team as needed.
• Acts on behalf of supervisor and/or other leadership when needed, inclusive of acting as on‑site leadership coverage with other PFS Leads. Assists in facilitating meetings with/for supervisor. Holds daily huddles, ensuring that changes and updates are communicated to the team.
• Partners with supervisor and analysts on payer forums, as well as process improvements. Helps create policies and processes for the PFS teams.
• Responsible for updating insurance coverage after claim has been generated and/or updating guarantor/patient demographics. Conducts rudimentary EOB/insurance processing review.
• Initiates coding or charge reviews to Research Institute (RI) and Health Information Management (HIM). Has in‑depth understanding and investigative skills required to review claim segments, identify modifiers, taxonomy, and NPI concerns.
• Sends simple appeals for timely filing, late discovery, other basic denials. Follows up with insurance companies for reprocessing of claims and status of appeals.
• Handles advanced projects, such as drafting appeals for HMS, LIDS and Ceris Audits. Completes audit process. Sends detailed appeals for LOMN, LOS, other advanced denials.

• Degrees
  • High School diploma or GED
• Area of Study
  • Not Applicable
• Experience
  • Minimum Experience
    
    Required:
    
    Five (5) years of healthcare and/or accounts receivable experience.
• Equivalency
  • Not Applicable
• Licenses & Certifications
  • None
• Additional Requirements
  • Not Applicable
• Competency
  • None

Pay is dependent on applicant's relevant experience.
Hourly Range: $23.31 to $34.97

Here, you matter. As a Children's Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career.

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