Patient Financial Specialist - Patient Financial Services PB

CHRISTUS Health•Corpus Christi, TX

About The Position

The Patient Financial Specialist provides support to the CHRISTUS Health Revenue Cycle division, ensuring patient account balances are resolved and reconciled in a timely and efficient manner. The role works collaboratively with a team to serve internal and external customers and follows CHRISTUS Health’s ethical standards, mission, philosophy, and core values. The specialist performs Revenue Cycle activities to meet performance, quality, and productivity standards; researches and applies payer and government requirements; responds to account inquiries; and communicates professionally to resolve outstanding account questions. Depending on assigned duties, the position may focus on billing, collections, or coordination with external vendors. Work includes claim review and correction, denial resolution, account follow-up and reconciliation, vendor account transfers and performance monitoring, and providing leadership with updates on errors, trends, and issues affecting reimbursement, productivity, payment delays, or patient experience. The position is scheduled 8:00 a.m.–5:00 p.m., Monday through Friday, and is full-time.

Requirements

High school diploma or equivalent years of experience.
Professional and effective written and verbal communication skills.
Working knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
Knowledge of standard billing forms and filing requirements, electronic claims editing and submission, and Medicare claim correction guidelines.
Ability to comply with CHRISTUS Health, payer, and government regulations.
No license, registration, or certification is required.

Nice To Haves

Post-high-school education.
1–3 years of experience.
Experience in a multi-facility hospital business office environment.
College education, previous insurance-company claims experience, or health care billing trade-school education may be considered in lieu of formal hospital experience.
Experience with inpatient and outpatient billing requirements for UB-04 and HCFA 1500 forms.
Experience with Medicare and Medicaid billing processes and regulations.
Understanding of Medicare terminology and ability to locate and reference CMS and/or Medicare regulations.

Responsibilities

Meet applicable OneCHRISTUS Competencies and Revenue Cycle performance, quality, and productivity expectations.
Collect and provide patient and payer information needed to resolve accounts.
Research and apply government-mandated claim submission requirements and payer-specific billing and follow-up rules.
Respond to account inquiries through written, verbal, or electronic correspondence and communicate effectively with internal and external customers.
Maintain knowledge of Revenue Cycle functions and applicable payer, government, and CHRISTUS Health regulations.
Apply CPT, HCPCS, and ICD-10 coding regulations and guidelines, and document account activity in designated systems according to policy and procedure.
Provide the PFS Leadership Team with updates about errors, issues, and trends affecting productivity, reimbursement, payment delays, or patient experience.
Review and work claim edits, payer-rejected claims, reports, and billing requests; correct claims in RTP status according to Medicare guidelines.
Collect balances due from payers and pursue appropriate reimbursement for services.
Identify and forward denial information to the appropriate departmental liaison and work toward timely denial resolution.
Use collection queues, systems, and reports to pursue accounts; identify and resolve underpayments and credit balances within payer deadlines.
Initiate Medicare Redetermination, Reopening, or Reconsideration when needed, and maintain knowledge of CMS 838 credit balance reporting.
Coordinate with external vendors and Revenue Cycle departments to monitor vendor activity and manage account placements, transfers, returns, recalls, and reconciliations.
Coordinate review of selected accounts with Revenue Cycle managers before transferring or placing them with external vendors.
Ensure vendor-closed or uncollectible accounts are properly reflected in applicable accounts receivable systems.
Maintain reports on vendor placements, collections, returns, and performance metrics; create tools or documentation that help leadership assess vendor performance.
Advise vendors on CHRISTUS Health billing and collection procedures and ensure accounts identified as having third-party coverage are billed as requested.
Audit vendor remittances and verify that fees comply with contracts and include supporting payment documentation.
Reconcile accounts between CHRISTUS Health and vendor systems.