Job Information
Children's Hospital Colorado Patient Financial Services Specialist in Aurora, Colorado
Job ID86416
LocationAurora, Colorado
Full/Part TimeFull-Time
Regular/TemporaryRegular
Why Work at Children's....
Here, it's different. Come join us. Children's Hospital Colorado has defined and delivered pediatric healthcare excellence for more than 100 years. Here, the nation's brightest nurses, physicians, scientists, researchers, therapists, and care providers are creating the future of child health. With an optimist's outlook, a trailblazing spirit, and a celebrated history, we're making new strides every day. We've been Magnet-designated four times by the American Nurses Credentialing Center and are consistently recognized among the best of the best pediatric hospitals with #1 rankings in Colorado and the region by U.S. News & World Report. As a national leader in pediatric care, we serve children and families from all over the nation. Our System of Care includes four pediatric hospitals, 11 specialty care centers, 1,300+ outreach clinics and more than 10,000 healthcare professionals representing the full spectrum of pediatric care specialties. Here, we know it takes all of us, every role, to deliver the best possible care to each child and family we treat. That's why we build our teams toward a foundation of equity in access, advancement, and opportunity. We know teams of individuals with different identities and backgrounds can nurture creativity and innovation. We know we can see, treat, and heal children better when our team reflects the diversity of our patient population. We strive to attract and retain diverse talent because we know a truly inclusive and equitable workforce will help us one day realize our most basic calling: to heal every child who comes through o A career at Children's Colorado will challenge you, inspire you, and motivate you to make a difference in the life of a child. Here, it's different.
Job Overview
The Patient Financial Services (PFS) Specialist supports various programs within the Patient Financial Services Department. This position supports advanced department administrative functions and provides high level customer service to both internal and external customers. The PFS Specialist works directly with leaders within PFS providing direct program support by root cause analysis and is responsible for quality control for Revenue Cycle, as well as process improvement. This position requires possession of a higher-level skillset and up-to-date knowledge of payer claim processing rules, reimbursement policies and regulations to partner with appropriate teams for support, attends meetings with leadership and other departments providing feedback and takeaways to the department that they support to ensure that the patient financial teams are aligned with any updated processes.
Additional Information
Department Name: Job Status: Full time, 40 hours per week Shift: Monday to Firday 8am to 5pm, Hybrid
Qualifications
Education: High School Diploma or equivalent required. Experience: Minimum five (5) years of healthcare and/or accounts receivable experience.
Responsibilities
POPULATION SPECIFIC CARE No direct patient care. ESSENTIAL FUNCTIONS An employee in this position may be called upon to do any or all of the following essential functions. * Responsible for outbound calls to insurance for follow-up. * Handles EDI management and PFS enrollments. * Responsible for CAS Ticket and Vendor management. * Credit card conversion (HB and PB) with Echo, Zelis and Vpay. * Responsible for updating insurance coverage after claim has been generated and/or guarantor/patient demographics. * Completes payer audit requests (primarily or partners with primary) in a timely and efficient manner. * Liaison with vendors to ensure PFS needs are being met and quality relationships continue. * Develops the quality and patient escalations program for patient experience and conducts reviews with staff to ensure patient satisfact on/resolutions. * Corrects rejected, incomplete and errored claims in Epic and the clearinghouse vendor. Sends simple appeals for timely filing, late discovery, other basic denials. * Conducts EOB/Insurance processing reviews, coverage change, and other advanced insurance activities. * Management of the Clearinghouse, including attending meetings, app management, creating logins, groups, adding providers to the Pro Table, and monitoring rejections. * Full understanding of contract summaries to advise correct applications for an account. * Handles Experian cases as needed for Dental EDI. * Maintains PFS e-mail box and is the liaison to other departments within CHCO. * Handles escalated payer and patient calls and proficiently discuss accounts, records, and services with patients/families. * Works all assigned work queues in a timely manner. * Ability to recognize deviations from contractual expectation and payor