Overview
A healthcare organization is seeking a Revenue Cycle Financial Specialist to join the Revenue Cycle - Patient Access Services Department. This role involves managing patient financial information, verifying insurance coverage, and assisting patients with financial processes related to hospital and physician services.
Responsibilities
- Collect and verify demographic, guarantor, and insurance information from patients.
- Educate patients, physicians, and staff on financial processes.
- Ensure preauthorizations, referrals, and precertifications are completed according to payer requirements before scheduled encounters.
- Collaborate with clinical staff to obtain necessary clinical information for authorization processes.
- Assist patients and their representatives in securing reimbursement for hospital and physician services.
- Help patients identify and select insurance coverage options or financial assistance.
- Work collaboratively with coverage vendors, clinical staff, patient financial services, ambulatory patient financial specialists, urban health collaborative, and case management/social work.
- Manage all patient account types including outpatient, inpatient, emergency department, and physician group accounts.
- Maintain thorough knowledge of the hospital's revenue cycle processes and inpatient/outpatient treatment policies.
- Coordinate and monitor revenue flow generated by hospital and physician group services.
- Utilize hospital revenue systems and interact regularly with patients, physicians, insurance companies, donors, and staff.
Essential Functions
- Perform registration functions by interviewing patients in person or via telephone to collect required data.
- Verify insurance benefits and coverage for scheduled services.
- Prioritize work to ensure all financial processes are completed before patient appointments.
- Obtain necessary referrals, authorizations, or precertifications to ensure reimbursement.
- Document authorization information accurately for clean billing and payment.
- Identify patients needing financial assistance and provide charity applications or referrals.
- Assist in managing resolution of multiple visit accounts in compliance with financial policies.
- Advise patients and guarantors on rights, responsibilities, and payment procedures.
- Act as an advocate to resolve inquiries and maintain positive guest relations.
- Use available resources to find appropriate financial resolutions for patients and the organization.
- Stay current on regulations affecting healthcare billing and financial assistance programs.
- Assist patients with financial assistance applications and ensure timely routing for consideration.
- Collaborate with Medicaid application vendors to facilitate timely completion of applications.
- Support patients in understanding Health Insurance Exchange plans and initiating enrollment processes.
- Collect payments due prior to services using designated payment systems.
- Investigate and resolve charge disputes, process refunds, identify account adjustments, and make corrections.
- Arrange payment plans for past due balances.
- Escalate issues requiring administrative review per treatment policies.
- Meet daily productivity and quality standards and participate in departmental audits.
- Perform other duties as assigned.
Required Qualifications
- Minimum of two years' experience in medical insurance verification and hospital finance areas, including hospital billing.
- Proficiency with Windows-based PC systems.
- Strong initiative and problem-solving skills.
- Excellent analytical and financial assessment abilities with attention to detail.
- Ability to multitask and adapt in a dynamic environment.
- Independent problem-solving capability and strong team management investment.
- Knowledge of accounting principles with excellent verbal, math, and presentation skills.
Preferred Qualifications
Position Details
- Employment Type: Full Time (1.00 FTE)
- Shift: Full Time - Days
- Department: Revenue Cycle - Patient Access Services
- Work Location: Remote / Burr Ridge, IL
- Collective Bargaining Agreement Code: 743 Clerical