Patient Financial Specialist - Patient Financial Services HB

CHRISTUS Health•Irving, TX

About The Position

The Patient Financial Specialist supports the Revenue Cycle division of CHRISTUS Health by ensuring patient-account balances are resolved and reconciled in a timely and efficient manner. The role works cooperatively with internal and external customers, follows applicable ethical standards and CHRISTUS Health policies, and supports the organization’s mission and core values. The specialist performs billing, collections, account follow-up, and related Revenue Cycle activities while meeting departmental quality, productivity, and performance standards. Duties include researching account issues and governmental requirements, collecting and providing patient and payer information, responding to account inquiries, and maintaining knowledge of payer-specific billing and follow-up guidelines, coding regulations, and applicable government requirements. The specialist documents work in patient accounting and other designated systems, communicates professionally with customers, and provides leadership with updates on errors, issues, and trends affecting productivity, reimbursement, payment delays, or patient experience. Depending on assigned functions, the role reviews claim edits and rejected claims, works billing reports and requests, corrects claims in RTP status, pursues payer balances and denials, identifies underpayments and credit balances, and initiates Medicare redeterminations, reopenings, or reconsiderations when needed. A Vendor Coordinator assignment also serves as liaison with external vendors, coordinates account placements and transfers, reconciles account information between systems, audits vendor remittances and fees, monitors vendor performance, and prepares tools and reports for Revenue Cycle leadership.

Requirements

High school diploma or equivalent years of experience required.
Professional and effective written and verbal communication skills required.
1–3 years of experience 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.
No license, registration, or certification required.

Nice To Haves

Post-high-school education preferred.
Experience in a multi-facility hospital business office preferred.
Experience with inpatient and outpatient billing requirements for UB-04 and HCFA 1500 forms preferred.
Experience with Medicare and Medicaid billing processes and regulations preferred.
Understanding of Medicare language preferred.
Knowledge of how to locate and reference CMS and/or Medicare regulations preferred.

Responsibilities

Meet applicable OneCHRISTUS Competencies and Revenue Cycle performance, quality, and productivity standards.
Collect and provide patient and payer information to facilitate account resolution.
Research applicable government requirements before claims submission and maintain knowledge of mandated regulations and updates.
Respond to account inquiries through written, verbal, or electronic correspondence.
Maintain payer-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations.
Communicate professionally and effectively with internal and external customers to resolve account questions and outstanding balances.
Comply with CHRISTUS Health, payer, and government regulations; apply CPT, HCPCS, and ICD-10 coding regulations and guidelines.
Document work in the patient accounting host system and other systems in accordance with policies and procedures.
Update the PFS Leadership Team about errors, issues, and trends affecting productivity, reimbursement, payment delays, or patient experience.
Review and work claim edits; process rejected claims for resubmission; work reports and billing requests.
Demonstrate knowledge of standard bill forms and filing requirements and electronic claims editing and submission capabilities.
Correct claims in RTP status in the designated claim system in accordance with Medicare guidelines.
Collect payer balances and follow up to ensure proper reimbursement for services.
Identify and forward denial information to the designated departmental liaison and pursue timely denial resolution.
Work the collector queue daily using appropriate collection systems and reports.
Identify and resolve underpayments and credit balances within payer time limits, and communicate trends affecting account resolution.
Initiate Medicare Redetermination, Reopening, and/or Reconsideration as needed.
For vendor coordination assignments, liaise with external vendors and Revenue Cycle departments to monitor timely receipt and acknowledgment of accounts placed for collection.
Manage account transfers between CHRISTUS Health and contracted vendors; coordinate account review before placement and return accounts to open receivables when appropriate.
Ensure vendor-designated closed or uncollectible accounts are properly reflected in applicable accounts-receivable systems.
Maintain reports measuring vendor placements, collections, returns, and performance metrics.
Advise vendors of CHRISTUS Health billing and collection procedures and ensure accounts with third-party coverage are billed as requested.
Audit vendor remittances and verify that fees comply with contracts and have supporting documentation for payments posted to patient accounting systems.
Create tools, reports, or documentation that help Revenue Cycle Leadership understand and measure vendor performance and prioritize relationships.
Reconcile accounts between CHRISTUS Health and vendor systems.