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 organizational goals and Patient Friendly standards. The role follows policies and procedures to ensure complete, accurate, and compliant processes that promote optimal collections and customer service. Responsibilities include collecting deductibles, co-pays, co-insurance, and payments on self-pay accounts; conducting in-depth demographic and financial assessments, generally at the bedside, to identify an appropriate payor source; and assisting patients with referrals to outside agencies. The specialist works collaboratively with Social Work and Outcomes Management to support the most appropriate continuum of care. The position interviews patients or their representatives to obtain demographic and financial information, evaluates possible payment and assistance options, communicates estimated financial responsibility, requests payment, and handles payments and receipts under departmental procedures. It also monitors high-dollar accounts, supports authorization and insurance verification, coordinates referrals and applications for government assistance, and maintains knowledge of revenue-cycle regulations and payer guidelines. The role may assist with disability applications and determinations, refer cases to outside vendors, participate in special revenue-cycle projects, and provide financial counseling support at other facilities. 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 stated education and experience requirements.
Knowledge of computer systems and financial counseling processes.
Ability to exercise judgment when assessing financial information, assistance eligibility, and payor sources.
Interpersonal skills for developing and maintaining professional relationships.

Responsibilities

Interview patients or their representatives, in accordance with HIPAA guidelines, to obtain complete and accurate demographic and financial information.
Follow assigned accounts through financial counseling processes in a timely and accurate manner.
Analyze collected information and pursue appropriate financial assistance and all possible 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.
Monitor high-dollar accounts to ensure complete and accurate information for timely account 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 and monitor timely completion of applications.
Maintain positive professional relationships with patients, peers, clinical departments, payor organizations, and industry organizations.
Keep current with governmental, managed-care, and third-party payor regulations and guidelines; explore options such as COBRA, liability, workers’ compensation, and government programs.
Contact the Social Security Administration and arrange patient appointments as needed; assist with interviews and required forms.
Coordinate disability determinations with clinical staff and disability examiners, and refer cases to appropriate outside vendors when additional post-discharge follow-up may be needed.
Complete assigned revenue-cycle projects, including complex patient review, processes with Communicare, and financial counseling at other facilities.
Escalate and determine issues requiring referral to appropriate internal or external management.
Meet departmental performance benchmark standards and participate in relevant training and career-development opportunities.