Patient Financial Specialist, PT, Days

Prisma Health•Greenville, SC

About The Position

The Patient Financial Specialist supports timely and appropriate resolution of patient accounts in accordance with Patient Friendly standards and organizational policies and procedures. The role promotes complete, accurate, and compliant financial processes to support collection and customer service performance. Responsibilities include collecting deductibles, co-pays, co-insurance, and payments on self-pay accounts; performing demographic and financial assessments, generally at the bedside, to identify appropriate payor sources; and helping patients contact external agencies when needed. The specialist works collaboratively with Social Work and Outcomes Management to support the most appropriate continuum of care for patients. The specialist interviews patients or their representatives to gather financial and demographic information, assesses available payment and assistance options, communicates estimated financial responsibility, and receives payments. The role also supports insurance verification and authorization, monitors high-dollar accounts, coordinates referrals to governmental agencies and outside vendors, and assists patients with disability-related applications and processes. Additional duties include maintaining revenue cycle knowledge, participating in training and special projects, and escalating issues to appropriate management.

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.
Use computer systems and financial counseling processes to follow through on assigned accounts accurately and promptly.
Analyze collected information and follow up to ensure patients receive consideration for financial assistance.
Identify and eliminate possible payor sources before considering hospital sponsorship.
Communicate estimated financial responsibility, request payment before or at the time of service, and explain insurance terms to patients.
Receive payments and issue receipts in accordance with departmental cash-handling procedures.
Meet performance benchmark standards.
Monitor high-dollar accounts to ensure complete and accurate information for timely submission and reimbursement.
Initiate authorization and insurance verification processes as necessary and communicate changes to relevant departments.
Coordinate referrals to the Department of Health and Human Services and monitor the timely completion of applications.
Maintain positive professional relationships with patients, peers, clinical departments, payor organizations, and industry organizations.
Stay current on governmental, managed-care, and other third-party payor regulations and guidelines.
Explore potential payor sources, including COBRA, liability, workers' compensation, and governmental agencies.
Participate in departmental training and career development opportunities.
Contact the Social Security Administration and arrange appointments for patients as needed; assist with interviews and required forms when needed.
Facilitate disability determinations by working with clinical staff and disability examiners to gather needed information.
Coordinate referrals to appropriate outside vendors when cases require follow-up after discharge.
Complete assigned revenue cycle projects, including participation in complex patient reviews, coordinating processes with Communicare, and assisting with financial counseling at other facilities.
Escalate issues to appropriate internal or external management.