The Team Lead must demonstrate a consistently high degree of proficiency in their primary position within Patient Financial Services Department of CHRISTUS Health. The Team Lead is responsible for a variety of activities in the department. The primary purpose of this position is to allow for professional growth and development within the organization, while applying one's expertise and knowledge within the unit. The position provides opportunities to increase one's scope of responsibility within the PFS Department. The position works in a cooperative team environment to provide value to internal and external customers, works in partnership with the management team and serves as a resource for innovation, staff support and process improvements. In addition to being able to perform the job duties as outlined in the job description of their primary role, a Team Lead must be able to meet the accountabilities outlined below.
The Team Lead 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.
Functions as a subject matter expert in support of other PFS team members and other departments/facilities within the CHRISTUS Health network.
Trains new staff in all areas as needed and provides source of knowledge for staff inquiries.
Demonstrate a good understanding of payer benefits requirements, on-line claims status, submission, billing, cash application, and reconciliation procedures.
Approve or deny requested adjustments and refunds within role thresholds.
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.
Remain flexible if duties are reassigned, which may involve transferring to a more appropriate unit in order to best serve PFS and CHRISTUS Health.
Display a professional, courteous and enthusiastic demeanor, while maintaining a positive self-image and perspective of the unit/company.
Responsible to contact CHRISTUS Health facility departments in order to resolve outstanding questions related to account or charge posting information to ensure account integrity and compliance with payer and/or government regulations and to ensure timeliness of follow-up activities.
Ensures quality and productivity standards are met or exceeded. Appropriately documents patient accounting host system or other systems utilized by Patient Financial Services in accordance with policy and procedures.
Provides continuous updates and information to Patient Financial Services Leadership Team regarding ongoing errors, payer related issues/trends, registration and other controllable QA related activities affecting productivity, reimbursement and/or payment delays.
Functions effectively within a team and participates and contributes constructively to produce results in a cooperative effort.
Continually seeks to understand and act upon customer needs, concerns, and priorities. Meets customer expectations and requirements, and gains customer trust and respect.
Demonstrates ongoing enthusiasm and commitment to the work assigned.
Works with Supervisor to receive feedback on performance and create a personal development plan.
- Must have minimum of 2 years experience in any of the following: Medicare, Medicaid and/or Commercial Insurance billing, collections, payment and reimbursement verification and/or refunds. Understanding of alternative Business Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred.
- 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.
B. Education and Training:
- HS Diploma or equivalency required
- Post HS education preferred
- Must have good verbal and written communication skills in order to present and explain information to internal and external customers.
- Ability to write letters.
- Must have practical experience with Word, Excel, Adobe applications.
- Must have ability to make independent decisions that are generally guided by established procedures.
- Must have a desire to learn ethical and compliant business practices.
- Must be able to handle sensitive, stressful and confidential situations and account information.
- Must have excellent keyboarding and 10-key skill-set.
- Must have knowledge to perform functions requiring the use of the internet.
- Willingness and ability to learn new tasks.
- Experience with the Medicare billing process -- what claims can be rebilled online vs doing a redetermination
- Understanding of Medicare language
- At least five years of experience billing, collecting and validating Medicare payment
- Understanding of how and when to bill Medicare as secondary
- Understanding of Medicare Dialysis billing
- How to read the information in the Common Working File -- HMO coverage, Hospice dates, COB screens etc.
- Hand's on experience with Medicare Remote -- DDE
- Understanding of and exposure to Medicare Recovery Audit Contractor
- Hand's on experience with working Medicare Status Locations (ex: RTP, Denied, Suspense)
- Experience with compiling both Redeterminations and Reopening's of Medicare claims
- Knowledgeable in locating and referencing CMS and/or Medicare Regulations
D. Licenses, Registrations, or Certifications: