Patient Financial Specialist Senior - Patient Financial Services

This associate 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 position operates within a cooperative team environment, delivering value to both internal and external customers while adhering to the highest ethical and moral standards. The associate will demonstrate proficiency in Patient Financial Services (PFS) and contribute to process improvements and innovation.

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 supporting 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 for resolution.
• Investigates and resolves complex payment denials, including correcting errors and supplying additional required information to facilitate reimbursement.
• Analyzes, recognizes, and resolves issues using strategic thinking.
• Adapts to process and procedure evaluations, supports continuous change, and manages special projects alongside normal workload.
• Demonstrates professional and effective written and verbal communication with internal and external customers.
• Exhibits strong working knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
• Documents patient accounting host systems or other systems in accordance with policy and procedures.
• Provides strategic business analysis updates to PFS Leaders and System Director regarding operational opportunities affecting reimbursement.
• Navigates Patient Accounting Systems, Document Imaging, Databases, and other tools efficiently.
• Understands Medicare and Commercial contract language.
• Works with MS Office products (Word, Excel, PowerPoint, Outlook) and develops advanced skills as needed.
• Understands government, non-government programs, billing, customer service, and cash applications.
• Possesses general hospital A/R accounts knowledge.
• Works ARSU Team Works reports to identify and communicate 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 to maintain compliance.
• Identifies, addresses, and communicates operational and financial risks.
• Resolves aged and/or problematic accounts.
• Utilizes multiple reporting systems to collect balances due from payors, ensuring proper reimbursement.
• Forwards proper account denial information to designated departmental liaisons.
• Ensures proper denial resolution and timely turnaround.
• Maintains knowledge of all governmental agency requirements and updates.
• Works collector queue daily using appropriate collection systems and reports.
• Demonstrates knowledge of standard bill forms and filing requirements.
• Identifies and resolves underpayments and credit balances within payor timely guidelines.
• Initiates Medicare Redetermination, Reopening, and/or Reconsideration as needed.
• Works unbilled and failed claim reports to resolve claim checks in the Patient Accounting host system.
• Exhibits understanding of electronic claims editing and submission capabilities.
• Performs research on Government and Non-Government Regulations related to claims submission.

Requirements

• High School Diploma or equivalent years of experience required; post-secondary education preferred.
• 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.
• Knowledge of Medicare, Medicaid, VA, Tricare billing and collections processes and regulations preferred.
• College education, previous Insurance Company claims experience, or health care billing trade school education may substitute for formal hospital experience.
• Hands-on experience with Medicare Remote (FISS) – DDE preferred.
• Strong technical aptitude with MS Office products (Word, Excel, PowerPoint, Outlook).
• Strong verbal and written communication skills.

Schedule

Full-time, Monday through Friday, 8 AM to 5 PM.