Patient Financial Services Specialist - Pharmacy

Children’s Hospital of Philadelphia•Philadelphia, PA

2d•$30 - $39•Onsite

About The Position

The Patient Financial Services (PFS) Specialist will lead projects and support the leadership team as a Subject Matter Expert in their field. The Specialist will handle complex issues, investigate denials, identify trends, and hold inter-departmental relationships. The Specialist will maintain internal controls, manage specialized functions and work queues and provide support for special projects. The position will have daily tasks assigned to them, dependent on team/department need. The Specialist must maintain the ability to handle requests from multiple sources and manage multiple deadlines. The position requires a person to act as a troubleshooter and resolve issues as they arise, and/or involve appropriate management personnel as needed. Must be committed to bringing projects to completion timely and identifying trends, root causes and efficiency opportunities. In the pharmacy space, the Specialist will also support complex pharmacy A/R scenarios, including payment posting, credit resolution, and pharmacy-specific collections. This includes navigating PBM (Pharmacy Benefit Managers) and PSAO (Pharmacy Services Administrative Organizations) processes, resolving pharmacy claim rejections, and collaborating closely with clinical and operational pharmacy staff.

Requirements

High School Diploma / GED - Required
At least three (3) years of work experience in healthcare billing or collections environment or other related role - Required
Demonstrated success in resolution of patient accounts; demonstrated ability to identify trends and complete assignments timely - Required
Strong math aptitude (Required proficiency)
Excellent organizational skills. (Required proficiency)
Clear and concise decision making skills (Required proficiency)
Leadership skills (Required proficiency)
Detail oriented (Required proficiency)
String interpersonal skills (Required proficiency)
Excellent writing and oral communication skills (Required proficiency)
Ability to work independently; results oriented (Required proficiency)
Ability to handle confidential matters. (Required proficiency)
Flexibility to work overtime as needed/required (Required proficiency)
Experience with personal computers including Excel (Required proficiency)

Nice To Haves

Bachelor's Degree - Preferred
Exposure to Epic, specifically Willow Ambulatory, is strongly preferred.
Experience with Epic system (Preferred proficiency)

Responsibilities

Acts as subject matter expert in their department, manages projects to timely completion, troubleshoots issues and maintains accurate and compliant workflows.
Holds inter-departmental relationships within PFS and outside of PFS; manages assigned workflows and work queues associated with these relationships and is the primary communicator with the department for any improvement opportunities.
Monitors work queues assigned as their responsibility, meeting established production and quality standards for the assigned tasks.
Specific focus is project oriented. Identify trends, training opportunities, denial prevention initiatives and maintaining internal controls for the department.
Performs workflow analysis, documents workflows, and testing planning in support of departments strategic and operational objectives.
Stays current on regulations and industry standard trends to ensure CHOP is compliant.
Responsible for creating presentation and data analytics to drive change and improvements.
Documents processes to help keep revenue cycle stakeholders informed and identify optimization opportunities.
Other duties as assigned.