Patient Financial Specialist Senior Job at CHRISTUS Health (Irving)

Job 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.

Job Responsibility

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
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.
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
Must have good understanding of the various areas of government, non-government programs, billing, customer service and cash applications
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
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 with the appropriate follow-up activities within payor timely guidelines
Initiates Medicare Redetermination, Reopening and/or Reconsideration as needed
Works reports and requests from the 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 the 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

Requirements

HS Diploma or equivalent years of experience required
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
Must have in-depth knowledge and ability to maneuver efficiently through Patient Accounting Systems, Document Imaging, Databases, etc.
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
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

Nice to have

Post HS education preferred
3-5 years of experience preferred
Medicare, Medicaid, VA, Tricare billing and collections processes and regulations preferred
Hands-on experience with Medicare Remote (FISS) – DDE preferred

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Patient Financial Specialist Senior

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