Patient Financial Representative Senior - BlueCross Collections
CHRISTUS Santa Rosa
CHRISTUS Santa Rosa Patient Financial Service Office
4803 NW Loop 410
San Antonio, TX 78229
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The Patient Financial Specialist Senior must demonstrate a consistently high degree of proficiency in their primary position within Patient Financial Services Department of CHRISTUS Health. The Patient Financial Specialist Senior is responsible for a variety of activities in the department. The primary purpose of this position is to evaluate unbilled accounts for qualification for combining with another account according to government and other payer regulations. In addition to being able to perform the job duties as outlined in the job description of their primary role, a Patient Financial Specialist Senior must be able to meet the accountabilities outlined below. The Patient Financial Specialist Senior will be responsible for performing collection functions to hospitals supported by the Corporate Patient Financial Services department. In doing so, ensures that all claims collected on meet all government and payor mandated procedures for Integrity and Compliance. Collect on claims in a prompt and efficient manner in accordance with state and federal laws that govern collection practices, while demonstrating a level of accountability to ensure data is with payor for claim processing. The collector is responsible for working with other Revenue Cycle departments for correction so that claims can be sent for continued adjudication. The collector is responsible for correspondence and returned mail that it is disseminated to the area for processing. The collector will participate in daily team briefings and communicate all issues impacting claim adjudication.
The Patient Financial Specialist Senior carries out his/her duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of CHRISTUS Health and fully supports CHRISTUS Health's core values of Dignity, Integrity, Compassion, Excellence and Stewardship.
- Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health key performance metrics.
- Ensures PFS departmental quality and productivity standards are met.
- Functions as a subject matter expert in support of other PFS team members and other departments/facilities within the CHRISTUS Health network.
- Demonstrate a good understanding of payer benefits requirements, on-line claims status, submission, and billing and collection procedures.
- Investigate and resolve complex payment denials inclusive of correcting errors and supplying additional required information to facilitate collection of reimbursement / additional reimbursement
- Interact with insurance companies to verify coverage, submit claims and follow up on appeals, underpayments, short pays or payment disputes
- Analyze payments from insurance companies to determine any underpayment and / or overpayments and resolve those discrepancies
- Contact patients to obtain insurance information
- Contact patients to obtain insurance information
- Ability to analyze and recognize payer issues
- Possesses strong knowledge in EXCEL, WORD, CHS Applications
- Ability to create and design reporting structure as necessary
- Best practices for collections – All payers / Ability to work multiple payers
- Maintains an active working knowledge of Government and Non-Government Regulations as it pertains to claims submission. Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission.
- Adapt to process and procedure evaluations and improvements, support continuous change, and willingly manage special projects in addition to normal workload and other duties as assigned.
- Responsible for professional and effective written and verbal communication with both internal and external customers.
- Exhibits a strong working knowledge of CPT, HCPCS and ICD-10 coding regulations and guidelines.
- Appropriately documents patient accounting host system or other systems utilized by PFS in accordance with policy and procedures.
- Provides strategic business analysis updates and information to PFS Leaders and System Director regarding operational opportunities affect reimbursement resulting in payment delays and/or loss revenue.
- Works reports and requests from facility or other revenue cycle areas
- Works and completes assigned collection insurance collection work queues on a daily basis which will include technical denials and at risk claims.
- Reviews accounts to check for qualification for combining according to both government and non-government payer rules and regulations and combines accounts as required to maintain compliance.
- Demonstrates strong knowledge of UBO4 / 1500 / Physician Billing and filing deadlines
- Exhibits and understanding of electronic claims editing and submission capabilities
- Maintains an active knowledge of all governmental agency requirements
- Identify, address and communicate operational and financial risks
- Resolve aged and/or problematic accounts
- Utilize multiple reporting systems
- Must work with the billing and collection teams
- Work with HIM and Medical Records teams to obtain medical records for claim processing
- HS Diploma or equivalency required
- Post HS education preferred
- Prefer three (3) years of experience and working knowledge of billing and or collections position within PFS.
- Experience calculating expected reimbursement according to payer regulations and/or contracts
- In-depth knowledge and ability to maneuver efficiently through Patient Accounting Systems, Document Imaging, Databases, etc. Strong understanding of systems from an end-user and processing perspective.
- Experience with Commercial, Medicare, and Medicaid reimbursement
- Medicare, Medicaid, VA, Tricare billing and collections processes and regulations preferred
- Understanding of Medicare and Commercial contract language
- Good technical aptitude working with a variety of MS Office products (Word, Excel, PowerPoint, Outlook) and/or ability to learn and develop more advance skills with the various applications.
- Strong verbal and written communication skills. Ability to effectively and efficiently articulate ideas to team members and management in a timely manner.
- Good understanding of the various areas of government, non-government programs, billing, customer service and cash applications.
- General hospital A/R accounts knowledge is required.
- College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
- Understanding of alternative Business Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred.