Patient Financial Services Specialist

Job Title:  Patient Financial Services Specialist
Job Location: Lincoln  

Status:  Hourly                     

I. JOB OVERVIEW

• Responsible for providing billing and reimbursement expertise by accurately processing claims expediently and error-free according to regulatory compliance and billing guidelines.
• Knowledge of multiple levels of care billing requirements and/or reimbursement methodologies include but not be limited to MS-DRG, CMG, RUGS, Case Mix, Long Term Care, Outpatient and physician professional billing is essential.
• Knowledge of organizational contractual arrangements, specific payer reimbursement methodologies, monitoring and assuring appropriate reimbursement is received for various Hospital Specialty areas as assigned.
• Work will be performed in an ethical and legal manner following organizational policies, processes, protocols and procedures.
• Responsible for quality service delivery and internal/external customer relations for Madonna as a whole, including upholding the mission and values for the department and facility.
   

II.  ESSENTIAL FUNCTIONS

     (INFORMATION)

1. Maintain and develop strong working knowledge in laws, regulations, policies, procedures for billing and collection of multiple specialty area as assigned.
2. Audit new chart demographic data, eligibility, monitor and report billing errors, actual reimbursement compared to expected, and denials.
3. Maintain current and complete knowledge of the accounts receivable system.
4. Analyze and review all patient and third party payor payments for accuracy and process immediately to expedite cash flow.
5. Compile and coordinate the processing of electronic and/or paper third party payor claims (primary, secondary, supplemental, liens)daily, weekly and/or monthly as appropriate for Medicare A and B, all Medicaid, Workers Compensation, commercial/liability insurance and managed care to expedite accurate maximum reimbursement.
6. Research and analyze all third party payor payments to verify accuracy and resubmit appeals or bill next payer/patient as appropriate.
7. Research analyzes and computes appropriate claims adjustments to keep accounts and financial classes current and accurate pursuant to organizational and/or payer contractual arrangements
8. Originate and expediently process Medicare No-Pay and Demand bills as necessary daily, weekly, monthly to comply with Medicare regulations.
9. Appropriately research and code MSP claims to comply with Medicare Secondary Claims regulations.
10. Verify accuracy of days and process Hospital Reserve Day letters to patients monthly as necessary to comply with Medicare regulations as delegated or assigned
11. Research, and monitor accounts to allow for timely processing of         estate demands/claims and/or liability liens within guidelines to safeguard maximum reimbursement due to Madonna.
12. Review and research credit balance account activity to expedite refunds as appropriate daily/weekly/monthly in an accurate and timely manner.
13. Monitor and process medical documentation/requests, secondary payor information, or any other requests as received to expedite payment and compliance to customer requests.
14. Record all pertinent conversation/actions for an account to provide an accurate documentation of collection efforts.
15. Research, analyze, document follow-up and maintain responsibility for maintaining A/R follow-up spreadsheets and for collection of accounts as assigned within the scope of departmental and facility goals.
16. Track daily task productivity reports and provide to Patient Financial Services Manager for further analysis.
17. Print bills, release electronic claim files daily, retrieve and post electronic payments, review and disseminate electronic claims reports and/or other related duties as assigned

      (PEOPLE)

1. Train in and Cross-train as needed as appropriate in areas of specialty expertise to allow for maximum coverage and to allow for personal and departmental goals to be met.
2. Receive and respond readily to questions regarding billing and status of reimbursement in specialty areas.
3. Assist patient/clients when necessary to evaluate their financial needs so that they have a   clear, concise understanding as to their financial responsibility regarding payment of the account.
4. Collaborate with internal and external customers in demanding situations while demonstrating commitment to service      excellence.
5. Communicate with resident/patients, families, co-workers and guests in a respectful and compassionate manner in accordance with the Madonna mission to ensure quality of service delivery.
6. Mentor, negotiate and intervene with patient/family who come Patient Financial Services for clarification and resolution of an account to ensure customer satisfaction.  
7. Answer phones to provide information courteously and promptly.
8. Communicate within department and cross-functional teams and with the Patient Financial Services Manager to share or inform of situations which may impact department or facility.
9. Provide backup for department staff when sick or on vacation to ensure efficient operation and quality of service.
10. Brings collection issues to Patient Financial Services Manager and/or designee for collaboration and resolution.
11. Follow instruction from Patient Financial Services Manager and/or designee to perform other functions as assigned in order to achieve the goals within the department.     

      (THINGS)

1. Must be able to operate copier, telephone, and calculator, fax machine and have proficient computer skills, including e-mail, word processing, presentation, excel spreadsheet functions and/or healthcare claims software. 
2. Maintain and ensure a safe environment for the department.  Handle and operate all necessary equipment and perform required duties according to established safety standards to maintain compliance with regulations and prevent injury.

III.  PHYSICAL DEMANDS AND ENVIRONMENTAL CONDITIONS

Light Work - Walk/stand constantly while stooping, pulling/ pushing file cabinets, reaching/climbing to retrieve computer printouts/storage material, twisting at desk to reach, type, answer phone and occasional lifting of approximately 20 pounds.  Manual dexterity and acuity for computer entry. Requires sufficient sight to see and read reports and computer screen.  Requires sufficient hearing and speaking to communicate by phone or in person. Inside office setting with noise from numerous telephones, keyboards, printers and simultaneous conversations.

IV.   QUALIFICATIONS (Education/training and/or Experience)

• High school equivalency with one year related work experience in health care billing and reimbursement or health care related field required.
• Current knowledge of Medicare, Medicaid, Workers Compensation or/or commercial insurance billing and reimbursement principles preferred.
• Requires strong skills in oral and written communication, math, reading, spelling and basic understanding of accounting principles.
• Attention to detail and excellent customer services skills required.   
• Must be self-motivated and demonstrate good organizational, problem solving and communication abilities. 
• Demonstrated computer skills required with basic knowledge of Excel spreadsheet and Word processing, proficient use of 10 key calculator and ability to operate various office machines. 
• Must have ability to work well in demanding situations and interact in positive manner with staff and public.

Madonna is an Equal Opportunity Employer.