Patient Financial Specialist Senior - Patient Financial Services - HB

CHRISTUS Health•Irving, TX

About The Position

The Patient Financial Specialist Senior supports the CHRISTUS Health Revenue Cycle division by ensuring patient-account balances are resolved and reconciled accurately and promptly. The role works cooperatively with internal and external customers, meets departmental quality and productivity standards, and performs Revenue Cycle functions in line with CHRISTUS Health performance metrics. The specialist demonstrates expertise in Patient Financial Services and serves as a subject matter resource for colleagues and other departments or facilities. In partnership with management, the role contributes to innovation, staff support, process improvements, and special projects while maintaining CHRISTUS Health’s ethical standards and core values. The position manages payer follow-up and complex account issues, including claims, appeals, denials, underpayments, short pays, payment disputes, aged accounts, and credit balances. It requires applying payer rules and contract terms, maintaining knowledge of government and commercial requirements, documenting work in Patient Accounting and related systems, and communicating trends and risks that affect reimbursement or account resolution. The specialist also uses reporting systems and collection work queues, supports billing audits and claim submission, and completes assigned work in accordance with payer deadlines and departmental procedures.

Requirements

High school diploma or equivalent years of experience required.
Experience calculating expected reimbursement according to payer regulations and/or contracts required.
Experience with commercial, Medicare, and Medicaid reimbursement.
Strong working knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
Knowledge of Medicare and commercial contract language.
General hospital accounts receivable knowledge.
Understanding of government and non-government programs, billing, customer service, and cash applications.
Strong verbal and written communication skills and ability to communicate ideas effectively and efficiently to team members and management.
Technical aptitude with Microsoft Office products, including Word, Excel, PowerPoint, and Outlook, or ability to develop advanced skills with applications.
Ability to work efficiently with patient accounting systems, document imaging, databases, and reporting systems.
Understanding of systems from an end-user and processing perspective.
Demonstrated ability to work with a variety of payers and apply applicable regulations, billing rules, and filing requirements.

Nice To Haves

Post-high-school education preferred.
Three to five years of experience preferred.
Medicare, Medicaid, VA, and TRICARE billing and collections processes and regulations preferred.
College education, prior insurance-company claims experience, and/or health-care billing trade-school education may be considered in lieu of formal hospital experience.
Hands-on experience with Medicare Remote (FISS) – DDE preferred.

Responsibilities

Meet applicable OneCHRISTUS competencies and Revenue Cycle performance metrics, as well as PFS quality and productivity standards.
Serve as a subject matter expert and resource for PFS team members and other CHRISTUS Health departments and facilities.
Interact with payers to verify coverage, submit claims, and follow up on appeals, underpayments, short pays, and payment disputes.
Investigate and resolve complex payment denials, correct errors, and provide information needed to obtain reimbursement or additional reimbursement.
Analyze issues and apply strategic thinking to resolve them; adapt to process evaluations and improvements, support change, and take on special projects as assigned.
Communicate professionally and effectively with internal and external customers, team members, and management.
Apply knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
Document account activity in the patient accounting host system and other PFS systems in accordance with policies and procedures.
Provide PFS leaders and the System Director with business analysis and updates about operational opportunities affecting reimbursement, payment delays, or revenue loss.
Use Patient Accounting systems, document imaging, databases, and other reporting systems effectively.
Work assigned insurance collection queues daily, including technical denials and at-risk claims, and use collection systems and reports to manage follow-up.
Review accounts for eligibility to combine under government and non-government payer rules, and combine them when required for compliance.
Identify, address, and communicate operational and financial risks; resolve aged or problematic accounts.
Collect amounts due from payers and pursue appropriate reimbursement for services.
Identify and forward denial information to the designated departmental liaison and work toward timely denial resolution.
Maintain current knowledge of governmental agency requirements and updates.
Identify and resolve underpayments and credit balances through appropriate follow-up within payer time limits.
Initiate Medicare Redetermination, Reopening, or Reconsideration when needed.
Work billing-audit reports and requests from facilities or other Revenue Cycle areas.
Work unbilled and failed-claim reports and resolve claim checks in the Patient Accounting host system.
Apply knowledge of standard bill forms, filing requirements, electronic claims editing and submission, and government and non-government claim-submission regulations.
Identify and communicate trends that affect account resolution.