Overview
A comprehensive academic medical center is seeking a Revenue Cycle Financial Specialist to join the Revenue Cycle - Patient Access Services Department. This role focuses on collecting and verifying patient demographic, guarantor, and insurance information, as well as educating patients, physicians, and staff on financial processes.
Responsibilities
- Ensure preauthorizations, referrals, and precertifications are completed according to payor 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 patients, 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.
- Perform all registration functions, including interviewing patients by phone or in person to collect demographic, guarantor, insurance, and financial data.
- Verify benefits and coverage for scheduled services.
- Prioritize work based on appointment dates to ensure completion before patient arrival.
- Obtain referrals, authorizations, or precertifications to ensure reimbursement and document authorization information for clean billing.
- Identify patients needing financial assistance and provide charity applications or referrals to appropriate agencies.
- Interview patients to assist in managing multiple visit accounts in compliance with hospital financial policies.
- Advise and counsel patients and guarantors on rights, responsibilities, and payment procedures for hospital and professional fee care.
- Act as an advocate to resolve inquiries and ensure positive guest relations.
- Use available resources to identify appropriate financial resolutions for patients and the organization.
- Stay current on city, county, state, and federal regulations affecting healthcare billing and financial assistance.
- Assist patients with financial assistance applications and ensure timely routing for consideration.
- Collaborate with patients and Medicaid vendors to facilitate timely Medicaid application completion.
- Support patients in understanding Health Insurance Exchange plans and initiating the application process.
- Collect payments due prior to services using designated payment systems.
- Investigate and resolve charge disputes, process refunds, identify necessary account adjustments, and make payment arrangements for past due balances.
- Escalate issues requiring administrative intervention per treatment policy.
- Meet daily productivity and quality standards and participate in departmental audits and reviews.
- Perform other duties as assigned.
Required Qualifications
- Minimum of two (2) years experience in medical insurance verification and hospital finance areas, including hospital billing.
- Proficiency with Windows-based PC systems.
- High initiative and strong problem-solving skills.
- Strong analytical and financial assessment abilities with attention to detail.
- Ability to multitask and adapt in a constantly changing environment.
- Independent problem-solving capability and commitment to team management.
- Knowledge of accounting principles with excellent verbal, math, and presentation skills.
Preferred Qualifications
Position Details
- Job Type/FTE: Full Time (1.00 FTE)
- Shift: Full Time - Days
- Department: Revenue Cycle - Patient Access Services
- Work Location: Full Time Remote / Burr Ridge, IL
- CBA Code: 743 Clerical