Patient Financial Specialist Senior - Patient Financial Services

This role provides support to the Revenue Cycle division of CHRISTUS Health, ensuring timely and efficient processes for account resolution and reconciliation of outstanding patient account balances. The associate works in a cooperative team environment, applying expertise to deliver value to internal and external customers while adhering to the highest ethical and moral standards.

Responsibilities

• Meets expectations of applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Performs Revenue Cycle functions to meet or exceed CHRISTUS Health key performance metrics.
• Ensures PFS departmental quality and productivity standards are met.
• Serves as a subject matter expert for other PFS team members and departments/facilities within the CHRISTUS Health network.
• Interacts with payers to verify coverage, submit claims, and follow up on appeals, underpayments, short pays, or payment disputes.
• Investigates and resolves complex payment denials, including correcting errors and supplying required information to facilitate reimbursement.
• Analyzes and resolves issues using strategic thinking.
• Works with a variety of payers and adapts to process improvements and change.
• Manages special projects in addition to normal workload.
• Demonstrates strong written and verbal communication with internal and external customers.
• Exhibits working knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
• Documents patient accounting systems in accordance with policy and procedures.
• Provides strategic business analysis updates to PFS Leaders regarding operational opportunities affecting reimbursement.
• Navigates Patient Accounting Systems, Document Imaging, Databases, and other systems efficiently.
• Understands Medicare and Commercial contract language.
• Uses MS Office products (Word, Excel, PowerPoint, Outlook) proficiently.
• Understands government, non-government programs, billing, customer service, and cash applications.
• Works ARSU Team reports to identify trends impacting account resolution.
• Completes assigned collection insurance work queues daily, including technical denials and at-risk claims.
• Reviews and combines accounts according to government and non-government payer rules.
• Identifies, addresses, and communicates operational and financial risks.
• Resolves aged and problematic accounts.
• Utilizes multiple reporting systems to collect balances due from payors.
• Forwards proper account denial information to designated departmental liaisons.
• Ensures timely denial resolution and turnaround.
• Maintains knowledge of governmental agency requirements and updates.
• Works collector queue daily using appropriate collection systems.
• Demonstrates knowledge of standard bill forms and filing requirements.
• Resolves underpayments and credit balances within payor timely guidelines.
• Initiates Medicare Redetermination, Reopening, and/or Reconsideration as needed.
• Reviews unbilled and failed claim reports to resolve claim checks.
• Exhibits understanding of electronic claims editing and submission capabilities.
• Maintains working knowledge of government and non-government regulations for claims submission.

Requirements

• High School Diploma or equivalent required; post-secondary education preferred.
• 3-5 years of experience preferred.
• Experience calculating expected reimbursement according to payer regulations/contracts.
• Experience with Commercial, Medicare, and Medicaid reimbursement.
• Medicare, Medicaid, VA, Tricare billing and collections processes preferred.
• College education, insurance claims experience, or healthcare billing trade school may substitute for formal hospital experience.
• Hands-on experience with Medicare Remote (FISS) – DDE preferred.

Schedule

• Full-time, Monday–Friday, 8 AM–5 PM.