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 these positions is to ensure account resolution and reconciliation of outstanding balances for CHRISTUS Health patient accounts. The position 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.
Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health key performance metrics.
Ensures PFS departmental quality and productivity standards are met.
Collects and provides patient and payor information to facilitate account resolution.
Maintains an active working knowledge of all Government Mandated Regulatations as it pertains to claims submission. Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission.
Responds to all types of account inquires through written, verbal or electronic correspondece.
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 Revenue Cycle.
Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding 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.
Provides continuous updates and information to PFS Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement and/or payment delays.
Review and work 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.
Correct claims in RTP status in designated claim system per Medicare guidelines.
Maintains an active knowledge of all governmental agency requirements and updates.
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 governmental agency requirements and updates.
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.
Corrects claims in RTP status in designated claim system per Medicare guidelines.
Initiates Medicare Redetermination, Reopening and/or Reconsideration as needed.
Working knowledge of the CMS 838 credit balance report.
Acts as liaison between external vendors and Revenue Cycle departments to monitor external vendor activities and ensures accounts placed for collection are received timely and acknowledged as received by the vendor.
Manages account transfers between CHRISTUS Health and the various contracted vendors.
Coordinates with Revenue Cycle Managers (Collections, Billing, Cash Applications, etc.) to review of selected accounts prior to transfer and placement with an external third party.
Ensures accounts deemed as closed or uncollectible by the vendors are properly reflected in applicable AR systems.
Maintains department reports measuring agency performance, which includes account placements, collections, returns and performance metrics.
Advises vendors of CHRISTUS Health billing and collection procedures and ensures accounts identified with third party coverage are properly billed by the entities as requested by the vendor.
Audits all vendor remittances and ensures all fees billed to CHRISTUS Health are in accordance with the contract and include supporting documentation of payments posted to the account on the patient accounting systems.
Recalls accounts incorrectly placed and/or as requested by Revenue Cycle Managers with the external vendor and returns accounts to open receivables as appropriate.
Creates tools, reports or documentation that enables Revenue Cycle Leadership to understand, manage and measure their vendor's performance and to prioritize important relationships.
Performs account reconciliation between CHRISTUS Health system and vendor system.
Prefer minimum of 2 years' experience with insurance billing, collections, payment and reimbursement verification and/or refunds.
Professional and effective written and verbal communication required.
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.
Experience with Medicare & Medicaid billing processes and regulations preferred.
Understanding of Medicare language.
Knowledge in locating and referencing CMS and/or Medicare Regulations 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.