Pt Financial Specialist

Patient Financial Specialist

Submits timely electronic and paper claims to third party payers in order to receive prompt payment from the payers.  Responds to questions from patients and/or third party payers relative to services or claims provided by the hospital.  Maintains Accounts Receivable within or below the state average benchmarks.  Communicates with third party payers on a daily basis.

Essential Job Functions:

• Submits electronic and/or paper claims to third party payers for payment in a timely manner in accordance with payer contracts.  Resolves any claim checks edits immediately in order to release a clean claim for printing or to be electronically transmitted.
• Keeps up to date with third party regulatory changes not limited to Medicare Local Coverage Determinations, Non Covered Determinations, and other third party payer policy changes within assigned third party financial class.
• Keeps up to date with third party precertification / prior authorization policies
• Maintains various ongoing follow-up procedures to resolve unpaid claims in a timely manner not to exceed 90 days.  Maintains that accounts/claims over 90 days from the date of first claims submission will not exceed 5% of total Accounts Receivable.
• Reviews and evaluates monthly Account Receivable reports to determine areas needing improvement
• Processes daily payment denials to determine if the third party carrier payment denial is accurate and is the patient’s responsibility.  If it is determined that the third party carrier payment denial is incorrect, additional resources not limited to telephone calls to third party carriers or patients, resubmitting the claims for re-processing, and/or appealing claims with the third party carrier will be required to have the claim reprocessed for payment.
• Cross training within third party financial classes not limited to Medicare, Medicaid, Blue Cross, Commercial and Worker’s Compensation.
• Ensures all correspondence (verbal and/or written) is processed within 2 days from the date of receipt.  Telephone message/voice mails are returned to the patient and/or insurance carrier within the same day.
• Able to work with highly confidential and sensitive patient information.
• Complies with hospital and departmental policies, procedures, regulations and standards as related to job.
• Demonstrates independent judgment in times of need, along with the ability to seek guidance and/or support from appropriate resources.

• Demonstrates hospital’s stated mission and values of teamwork, respect and communication with co-workers, patients, families and visitors.
• Actively and appropriately participate in problem-solving identification and resolution, both intra- and inter-departmentally.
• Meet department customer service standards and strives to enhance the level of customer service provided.

Qualifications:

• Education      

Required:  High School Graduate or equivalent 

Preferred:  Two years post-secondary education in accounting or business administration preferred

• Work Experience

Required:  Strong work experience with third party carriers

Preferred:  Two years or more in healthcare medical billing or medical office setting

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• Other Skills/knowledge
  Required:  Knowledge of computer keyboarding, electric insurance billing, ability to operate standard office equipment including computer, copy machine, printer, calculator, and fax machine.

Preferred:  Experience with Excel and Word.  Knowledge of current NH Insurance Rules and Regulations.  Comprehension of Federal Compliance and HIPAA regulations.