Patient Financial Specialist Lead - Commercial Collections Blue Cross (Sign-on Incentive Available)
Location: San Antonio, Texas
Internal Number: 9828100
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.
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 collection requirements by payors.
Works collector queue daily utilizing appropriate collection system and reports.
Demonstrates knowledge of standard bill forms and filing requirements.
Identify and resolve underpayments with the appropriate follow up activities within payor timely guidelines.
Identify and resolve credit balances with the appropriate follow up activities within payor timely guidelines.
Identify and communicate trends impacting account resolution.
HS Diploma or equivalency required
Post HS education preferred
Three (3) years of experience and working knowledge of primary position within PFS preferred. Strong candidates, with supervisor/manager recommendation, may be fast tracked to a Team Lead position prior to reaching the 3 year experience requirement based on consistent display of qualities listed above.
Achieve a standard score of 3.20 or higher on annual performance evaluation as well as exceeding standards on Quality Assurance (QA) reviews and Productivity standards.
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.
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.
Ability to train new staff in all areas as needed and provide source of knowledge for staff inquiries.
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.
Demonstrated success working in a team environment focused on meeting organization goals and objectives required.
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.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.