Patient Financial Specialist Senior - Patient Financial Services

Responsibilities

• 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.
• Maintains an active knowledge of all governmental agency requirements and updates.
• Works collector queue daily utilizing appropriate collection system and reports.
• Identifies and resolves underpayments and credit balances with the appropriate follow-up activities within payor timely guidelines.
• Initiates Medicare Redetermination, Reopening and/or Reconsideration as needed.

Qualifications

• HS Diploma or equivalent years of experience required.
• Post HS education preferred.
• Experience 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.