The associate is responsible for the duties and services that are of a support nature to the Revenue Cycle division of CHRISTUS Health. The associate ensures that all processes are performed in a timely and efficient manner. The primary purpose of this position is to ensure account resolution and reconciliation of outstanding balances for CHRISTUS Health patient accounts. The position works in a cooperative team environment to provide value to internal and external customers. The associate must demonstrate a consistently high degree of proficiency in their primary position within Patient Financial Services Department of CHRISTUS Health. The associate is responsible for a variety of activities in the department 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. Working in partnership with the management team, serves as a resource for innovation, staff support and process improvements.
The associate 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.
- Demonstrates a good understanding and has the ability to interact with the payer to verify coverage, submit claims, follow up on appeals, underpayments, short pays or payment disputes for resolution.
- Investigate and resolve complex payment denials inclusive of correcting errors and supplying additional required information to facilitate collection of reimbursement / additional reimbursement.
- Ability to analyze, recognize, and resolve issues utilizing strategic thinking.
- Level of knowledge and the ability to work with a variety of payers.
- 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.
Role Specific Responsibilities
- Works reports and requests from facility or other revenue cycle areas to identify and communicate trends impacting account resolution.
- 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.
- Identify, address, and communicate operational and financial risks
- Resolve aged and/or problematic accounts
- Utilize multiple reporting systems
- Collect balances due from payors ensuring proper reimbursement for all services.
- Identifies and forwards proper account denial information to the designated departmental liaison. Dedicates efforts to ensure a proper denial resolution and timely turnaround.
- Maintain an active knowledge of all governmental agency requirements and updates.
- Works collector queue daily utilizing appropriate collection system and reports.
- Demonstrates knowledge of standard bill forms and filing requirements.
- Identify and resolve underpayments and credit balances with the appropriate follow up activities within payor timely guidelines.
- Initiates Medicare Redetermination, Reopening and/or Reconsideration as needed.
- 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.
- Prefer hands on experience with Medicare (FISS) - DDE.