Patient Financial Specialist, FT, Days

Prisma Health

About The Position

The Patient Financial Specialist supports timely and appropriate resolution of patient accounts while following Patient Friendly standards, organizational policies, and compliant procedures. The role promotes collection and customer-service performance by collecting deductibles, co-pays, co-insurance, and payments toward self-pay accounts. It performs in-depth demographic and financial assessments, generally at the bedside, to identify appropriate payor sources and potential financial assistance. Follow-up may include helping patients contact outside agencies such as Vocational Rehabilitation, the Department of Health and Human Services, and the Social Security Administration. The specialist works collaboratively with Social Work and Outcomes Management to support the patient’s appropriate continuum of care. The position interviews patients or their representatives, assesses account and insurance information, explains estimated financial responsibility and insurance terms, requests and receives payments, and follows departmental cash-handling procedures. It monitors high-dollar accounts, supports authorization and insurance verification, coordinates applications and referrals, assists with disability determinations, and handles special revenue-cycle projects. This is a non-management position reporting to a supervisor, manager, director, or executive.

Requirements

High school diploma or equivalent.
Three years of healthcare revenue-cycle experience, such as billing, collections, and/or customer service.
Alternatively, a bachelor’s degree and three years of service-industry experience may substitute for the listed education and experience requirements.

Responsibilities

Interview patients or their representatives, in accordance with HIPAA guidelines, to obtain complete and accurate demographic and financial information.
Follow assigned accounts through resolution using computer systems and financial counseling processes, meeting timeliness and accuracy expectations.
Analyze collected information and pursue available financial assistance and payor sources before considering hospital sponsorship.
Communicate estimated patient financial responsibility, explain insurance terms, and request payment before or at the time of service.
Receive payments and issue receipts in accordance with departmental cash-handling procedures.
Meet performance benchmark standards.
Monitor high-dollar accounts for complete and accurate financial and demographic information needed for timely submission and reimbursement.
Initiate authorization and insurance verification processes as needed and communicate relevant changes to affected departments.
Coordinate referrals to the Department of Health and Human Services for application completion and monitor that applications are obtained promptly.
Develop and maintain positive professional relationships with patients, peers, clinical departments, payor organizations, and industry organizations.
Maintain revenue-cycle knowledge by reviewing governmental, managed-care, and other third-party payor regulations and guidelines.
Explore potential payor sources, including COBRA, liability, workers’ compensation, and government agencies.
Participate in departmental training and career-development opportunities.
Contact the Social Security Administration and arrange patient appointments as needed; assist patients with interviews and required forms when needed.
Coordinate the disability determination process with clinical staff and disability examiners by gathering needed information.
Refer cases to appropriate outside vendors when follow-up may be needed after hospital discharge.
Complete assigned revenue-cycle special projects, including participation with the complex patient review team, coordinating processes with Communicare, and assisting with financial counseling at other facilities.
Escalate issues to appropriate internal or external management when warranted.