Revenue Cycle Financial Specialist - PFX, Full time - Days

Job Description

Be a part of a world-class academic healthcare system, Uchicago Medicine, as a Rev Cycle Financial Specialist - PFX in Rev Cycle Admin Department. This position requires you to work onsite 1 week and WFH 4 weeks. You will need to be based in the greater Chicagoland area.

 

 

In this role Revenue Cycle Financial Specialist-PFX will be responsible for collecting and verifying demographic, guarantor and insurance information, educate patients, physicians, staff, etc. on the financial process.

 

Job Summary 

• Responsible for ensuring that preauthorization’s/referrals and precertification’s are in completed in accordance with payor requirements and prior to the scheduled encounter.
• Work closely with the staff in the clinical areas to acquire necessary clinical information needed to complete authorization process
• Manage the process of aiding patients and their representatives with securing reimbursement for Hospital and Physician services provided
• Assist patients in identifying and selecting an available option for insurance coverage and/or financial assistance.
• Work collaboratively with patients, UCM “coverage vendors” – currently GLM, clinical staff, Patient Financial Services, Ambulatory Patient Financial Specialists, urban health collaborative and case management/social work
• Manage all patient account types; outpatient, inpatient, ED and UCPG, and maintain a thorough knowledge of the hospitals revenue cycle process
• Understand the Hospitals Inpatient/Outpatient treatment policies and how they relate to each patient situation Have the responsibility of coordinating and monitoring the flow of revenue generated not only by UCMC but UCPG
• You will be involved in extensive utilization of the Hospitals revenue systems and constant interaction with patients, physicians, insurance companies, donors and other members of the Hospitals' staff 

 

Essential Functions

• Perform all registration functions: interview patients via telephone or face to face to collect demographic, guarantor, insurance and financial data required
• Verify the benefits as well the coverage for services scheduled
• Prioritize work based on appointment date to ensure everything is completed prior to the patient arriving at UCM
• Obtain referrals/authorizations or precertification’s to ensure reimbursement of services rendered Document necessary authorization information in appropriate fields for clean billing and payment
• Recognizes those patients in need of financial assistance, and provides charity applications or referrals to the Department of Human Services
• Interview the patients to be able to assist in managing a resolution of a patient’s multiple visit accounts and be compliant with Hospital financial resolution policies
• Advise and counsel patients and guarantors regarding patient rights, responsibilities and procedures as it relates to payment for Hospital and ProFee care
• Act as an advocate to ensure positive guest relations for resolution of inquiries
• Utilize all available resources to identify the most appropriate financial resolution for both the patients and UCM
• Remain current of any city, county, state or federal regulation(s) that may change the structure and management of the current Affordable Health Care Act or Fair Patient Billing Act guidelines
• Assists patients with financial assistance applications
• Ensure completed Financial Assistance applications get routed to the appropriate department for consideration in a timely manner
• Work closely with both the patient and UCM MA-NG vendor to assist in the completion of the Medicaid application. This will ensure that the Medicaid applications are completed in a timely manner
• Assist the patient in understanding the Health Insurance Exchange plans potentially available to them, and support the patient in contacting the UCM MA-NG vendor to start the process
• Collect any necessary payments due prior to services being rendered using PPE system through PASSPORT
• Investigate and resolve charge disputes, process patient refunds, identify adjustments required to accounts and make corrections. Make payment arrangements on past due balances
• Escalate issues that per Treatment Policy that require administrative intervention or review
• Meet daily productivity and quality expectations and participate openly in departmental audit/review process to ensure that all work is monitored and completed based on departmental standards.
• Other Duties Assigned

 

Required Qualifications

• Two ( 2 ) years’ experience in medical insur