Patient Financial Specialist

Christus Health; Santa Fe (NM); On-site; USD 42,000 - 64,000; Full time

Job summary

Christus Health is seeking a Patient Financial Specialist in Santa Fe, NM to drive timely resolution of patient balances within the Revenue Cycle. You will collaborate with payors and internal teams to ensure accurate accounts and compliant submission.

The role requires familiarity with UB-04/HCFA 1500, Medicare/Medicaid processes, and strong communication to resolve questions from patients and providers. On-site, full-time position with focus on accuracy and efficiency.

Qualifications

• HS Diploma or equivalent experience required.
• Post-HS education preferred.
• 1-3 years of experience preferred.
• Experience in a multi-facility hospital business office environment preferred.
• Experience with UB-04 and HCFA 1500 inpatient and outpatient billing requirements preferred.
• Experience with Medicare & Medicaid billing processes and regulations preferred.
• Understanding of Medicare language preferred.

Responsibilities

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Performs Revenue Cycle activities to meet or exceed CHRISTUS Health key performance metrics.
• Ensures departmental PFS quality and productivity standards are met.
• Collects and provides patient and payor information to facilitate account resolution.
• Maintains current working knowledge of Government Mandated Regulations for claim submission, including researching proper governmental requirements prior to submission.
• Responds to account inquiries via written, verbal, or electronic communication.
• Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines for third-party payers.
• Maintains working knowledge of all functions within the Revenue Cycle.
• Provides professional, effective communication to internal and external customers to resolve outstanding account questions.
• Maintains compliance with CHRISTUS Health, payer, and government regulations.
• Applies knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
• Documents patient accounting activity in the patient accounting host system or other PFS systems per policy and procedures.
• Provides continuous updates to the PFS Leadership Team on errors, issues, and trends impacting productivity, reimbursement, payment delays, and/or patient experience.
• Reviews and works claim edits.
• Works payor rejected claims for resubmission.
• Works reports and billing requests, applying strong knowledge of bill forms and filing requirements.
• Demonstrates understanding of electronic claims editing and submission capabilities.
• Corrects claims in RTP status in the designated claim system per Medicare guidelines.
• Stays current on governmental agency requirements and updates.
• Collects balances due from payors to ensure proper reimbursement for services.
• Identifies and forwards proper account denial information to the designated departmental liaison to support denial resolution and timely turnaround.
• Works the collector queue daily using appropriate collection systems and reports.
• Identifies and resolves underpayments and credit balances using follow-up activities within payor timely guidelines.
• Identifies and communicates trends impacting account resolution.
• Initiates Medicare Redetermination, Reopening and/or Reconsideration as needed.
• Maintains working knowledge of the CMS 838 credit balance report.
• Serves as a liaison between external vendors and Revenue Cycle departments, monitoring vendor activity and ensuring accounts placed for collection are received and acknowledged.
• Manages account transfers between CHRISTUS Health and contracted vendors.
• Coordinates with Revenue Cycle Managers to review selected accounts prior to transfer and placement with an external third party.
• Ensures vendor-closed or uncollectible accounts are properly reflected in applicable AR systems.
• Maintains department reports measuring agency performance, including placements, collections, returns, and performance metrics.
• Advises vendors on CHRISTUS Health billing and collection procedures and ensures third-party coverage accounts are billed as requested by the vendor.
• Audits vendor remittances and verifies fees billed to CHRISTUS Health align with the contract and include supporting documentation for payments posted to patient accounting systems.
• Recalls incorrectly placed accounts as requested by Revenue Cycle Managers and returns accounts to open receivables when appropriate.
• Creates tools, reports, or documentation to help Revenue Cycle Leadership understand, manage, and measure vendor performance and prioritize relationships.
• Performs account reconciliation between the CHRISTUS Health system and vendor system.

Education

HS Diploma or equivalent

Post-HS education preferred

Job description

The Patient Financial Specialist supports the Revenue Cycle division by driving timely account resolution and accurate reconciliation of outstanding patient balances.

Responsibilities

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Performs Revenue Cycle activities to meet or exceed CHRISTUS Health key performance metrics.
• Ensures departmental PFS quality and productivity standards are met.
• Collects and provides patient and payor information to facilitate account resolution.
• Maintains current working knowledge of Government Mandated Regulations for claim submission, including researching proper governmental requirements prior to submission.
• Responds to account inquiries via written, verbal, or electronic communication.
• Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines for third-party payers.
• Maintains working knowledge of all functions within the Revenue Cycle.
• Provides professional, effective communication to internal and external customers to resolve outstanding account questions.
• Maintains compliance with CHRISTUS Health, payer, and government regulations.
• Applies knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
• Documents patient accounting activity in the patient accounting host system or other PFS systems per policy and procedures.
• Provides continuous updates to the PFS Leadership Team on errors, issues, and trends impacting productivity, reimbursement, payment delays, and/or patient experience.
• Reviews and works claim edits.
• Works payor rejected claims for resubmission.
• Works reports and billing requests, applying strong knowledge of bill forms and filing requirements.
• Demonstrates understanding of electronic claims editing and submission capabilities.
• Corrects claims in RTP status in the designated claim system per Medicare guidelines.
• Stays current on governmental agency requirements and updates.
• Collects balances due from payors to ensure proper reimbursement for services.
• Identifies and forwards proper account denial information to the designated departmental liaison to support denial resolution and timely turnaround.
• Works the collector queue daily using appropriate collection systems and reports.
• Identifies and resolves underpayments and credit balances using follow-up activities within payor timely guidelines.
• Identifies and communicates trends impacting account resolution.
• Initiates Medicare Redetermination, Reopening and/or Reconsideration as needed.
• Maintains working knowledge of the CMS 838 credit balance report.
• Serves as a liaison between external vendors and Revenue Cycle departments, monitoring vendor activity and ensuring accounts placed for collection are received and acknowledged.
• Manages account transfers between CHRISTUS Health and contracted vendors.
• Coordinates with Revenue Cycle Managers (Collections, Billing, Cash Applications, etc.) to review selected accounts prior to transfer and placement with an external third party.
• Ensures vendor-closed or uncollectible accounts are properly reflected in applicable AR systems.
• Maintains department reports measuring agency performance, including placements, collections, returns, and performance metrics.
• Advises vendors on CHRISTUS Health billing and collection procedures and ensures third-party coverage accounts are billed as requested by the vendor.
• Audits vendor remittances and verifies fees billed to CHRISTUS Health align with the contract and include supporting documentation for payments posted to patient accounting systems.
• Recalls incorrectly placed accounts as requested by Revenue Cycle Managers and returns accounts to open receivables when appropriate.
• Creates tools, reports, or documentation to help Revenue Cycle Leadership understand, manage, and measure vendor performance and prioritize relationships.
• Performs account reconciliation between the CHRISTUS Health system and vendor system.

Requirements

• HS Diploma or equivalent experience required.
• Post-HS education preferred.
• 1-3 years of experience preferred.
• Experience in a multi-facility hospital business office environment preferred.
• College education, previous insurance company claims experience, and/or health care billing trade school education may be considered in lieu of formal hospital experience.
• Experience with UB-04 and HCFA 1500 inpatient and outpatient billing requirements preferred.
• Experience with Medicare & Medicaid billing processes and regulations preferred.
• Understanding of Medicare language preferred.
• Knowledge locating and referencing CMS and/or Medicare regulations preferred.
• None required.

Schedule

• 5 Days - 8 Hours

Work Type

• Full Time