The Patient Financial Specialist Senior must demonstrate a consistently high degree of proficiency in their primary position within Patient Financial Services Department of CHRISTUS Health.The Patient Financial Specialist Senior is responsible for a variety of activities in the department. The primary purpose of this position is to evaluate unbilled accounts for qualification for combining with another account according to government and other payer regulations.In addition to being able to perform the job duties as outlined in the job description of their primary role, a Patient Financial Specialist Senior must be able to meet the accountabilities outlined below.
The Patient Financial Specialist Senior 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.
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.
Demonstrate a good understanding of payer benefits requirements, on-line claims status, submission, billing and collection procedures.
Maintains an active working knowledge of Government and Non-Government Regulations as it pertains to claims submission. Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission.
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 customersin order to resolve outstanding for account resolution
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 continuous updates and information to PFS Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement and/or payment delays.
Works reports and requests from 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 reports to resolve claim checks in Patient Accounting host system.
Demonstrates strong knowledge of standard bill forms and filing requirements.
Exhibits and understanding of electronic claims editing and submission capabilities
Maintains an active knowledge of all governmental agency requirements and updates
Identify and communicate trends impacting account resolution
HS Diploma or equivalency required
Post HS education preferred
Prefer three (3) years of experience and working knowledge of billing and or collections position within PFS.
Experience calculating expected reimbursement according to payer regulations and/or contracts
In-depth knowledge and ability to maneuver efficiently through Patient Accounting Systems, Document Imaging, Databases, etc. Strong understanding of systems from an end-user and processing perspective.
Experience with Medicare & Medicaid billing processes and regulations preferred
Understanding of Medicare language
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.
Strong verbal and written communication skills. Ability to effectively and efficiently articulate ideas to team members and management in a timely manner.
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.
College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
Understanding of alternative Business Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.