Description
Summary:
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 Job is to ensure account resolution and reconciliation of outstanding balances for CHRISTUS Health patient accounts. The Job works in a cooperative team environment to provide value to internal and external customers.
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 Mission, Philosophy, and core values of Dignity, Integrity, Compassion, Excellence, and Stewardship.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health’s key performance metrics.
• Ensures PFS departmental quality and productivity standards are met.
• Collects and provides patient and payor information to facilitate account resolution.
• Responds to all types of account inquiries through written, verbal, or electronic correspondence.
• Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers. Maintains working knowledge of all functions within the Revenue Cycle.
• Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution.
• Meets or exceeds customer expectations and requirements, and gains customer trust and respect.
• Compliant with all CHRISTUS Health, payer, and government regulations.
• 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.
• Provide continuous updates and information to the PFS Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement, payment delays, and/or patient experience.
• Must have professional and effective written and verbal communication.
• Billing
• Review and work on claim edits.
• Works payor rejected claims for resubmission.
• Works reports and billing requests.
• Demonstrates strong knowledge of standard bill forms and filing requirements.
• Exhibits and understanding of electronic claims editing and submission capabilities.
• Collections
• Collect balances due from payors ensuring proper reimbursement for all services.
• Identifies and forwards proper account denial information to the designated departmental liaison. Dedicated 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.
• Cash Reconciliation
• Ensures all payments are retrieved and posted accurately and timely through reconciliation of patient accounting system and bank statement.
• Researches submitted cash payments by verifying patient account numbers and appropriate facilities.
• Monitor and performs cash reconciliation to identify cash posting errors and ensures all receipts are applied and reconciles to daily bank deposit and monthly bank statements.
• Review and post cash corrections, including resolving patient complaints and inquiries from PFS, Finance, Facilities, and Vendor Partners.
• Resolve and Research unapplied cash, including continuous follow-up until payment identification is made for application of payment or refund.

Job Requirements:

EDUCATION/SKILLS

• HS Diploma or equivalent years of experience required.
• Post HS education preferred.

EXPERIENCE

• 3-5 years of experience preferred.
• Experience working within 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 working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred.

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health’s key performance metrics.
• Ensures PFS departmental quality and productivity standards are met.
• Collects and provides patient and payor information to facilitate account resolution.
• Responds to all types of account inquiries through written, verbal, or electronic correspondence.
• Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers. Maintains working knowledge of all functions within the Revenue Cycle.
• Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution.
• Meets or exceeds customer expectations and requirements, and gains customer trust and respect.
• Compliant with all CHRISTUS Health, payer, and government regulations.
• 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.
• Provide continuous updates and information to the PFS Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement, payment delays, and/or patient experience.
• Must have professional and effective written and verbal communication.
• Billing
• Review and work on claim edits.
• Works payor rejected claims for resubmission.
• Works reports and billing requests.
• Demonstrates strong knowledge of standard bill forms and filing requirements.
• Exhibits and understanding of electronic claims editing and submission capabilities.
• Collections
• Collect balances due from payors ensuring proper reimbursement for all services.
• Identifies and forwards proper account denial information to the designated departmental liaison. Dedicated 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.
• Cash Reconciliation
• Ensures all payments are retrieved and posted accurately and timely through reconciliation of patient accounting system and bank statement.
• Researches submitted cash payments by verifying patient account numbers and appropriate facilities.
• Monitor and performs cash reconciliation to identify cash posting errors and ensures all receipts are applied and reconciles to daily bank deposit and monthly bank statements.
• Review and post cash corrections, including resolving patient complaints and inquiries from PFS, Finance, Facilities, and Vendor Partners.
• Resolve and Research unapplied cash, including continuous follow-up until payment identification is made for application of payment or refund