• Creating a Positive Impression: The specialist's primary responsibility is to create a positive impression of the hospital's resources for patients, families, and external customers, whether interacting over the phone or in person.

• Collaboration with Various Stakeholders: Working closely with patients, healthcare providers, colleagues, and insurance companies to ensure patient needs are met effectively and efficiently.

• Pre-Visit Coordination: Involvement in the pre-visit process, which includes tasks like:

  • Patient Identification: Verifying and updating patient information.
  • Pre-Registration: Ensuring that all required patient details are entered into the system before the visit.
  • Pre-Authorization: Ensuring any necessary authorizations from insurance companies are obtained prior to appointments.
  • Scheduling Appointments: Coordinating and scheduling patient appointments.

• Payment and Financial Assistance: The specialist is responsible for:

  • Payment Options: Offering different payment options to patients.
  • Collecting Patient Balances: Gathering any balances due from patients, when appropriate.
  • Financial Assistance Referrals: Initiating referrals for financial assistance based on patient needs, in accordance with applicable Illinois state laws (e.g., Illinois Fair Patient Billing Act, Illinois Uninsured Patient Discount Act).

• Compliance and Knowledge: Maintaining up-to-date knowledge of key regulations and standards, such as:

  • Joint Commission Standards: Ensuring the hospital meets these accreditation requirements.
  • Patient Rights and Responsibilities: Understanding and upholding patient rights and responsibilities.
  • HIPAA Compliance: Ensuring patient information is handled in accordance with HIPAA regulations.
  • Hospital Policies and Procedures: Adhering to internal hospital policies.

• Shift and Schedule: The role operates on a full-time schedule (1.0 FTE), with a shift from 8:00 AM to 4:00 PM, Monday through Friday. There are no weekend shifts.

This position requires a strong focus on customer service, effective communication, and financial assistance coordination, alongside a solid understanding of healthcare regulations and hospital procedures.

Education:

High School diploma or GED equivalent required. 

Experience:

• Two (2) years of business office experience, preferably in the areas of Patient Access, billing, collections, insurance principles/practices, or accounts receivable. Previous experience in Patient Financial Services is highly desirable.
• 3+ years of customer service experience required. Medical terminology, medical office registration or billing experience strongly preferred.
• CPSI/Evident systems experience preferred.

Other Knowledge/Skills/Abilities:

• Knowledge of medical terminology, Current Procedural Terminology (CPT,) HCPCS, CCI Edits, diagnosis (ICD-10 CM) coding and procedural (ICD-10 PCS) coding, Revenue Codes, as well as UB-04 and Explanation of Benefits (EOB) interpretation.
• Working knowledge of computers is required, with the ability to enter and retrieve data, and electronically notate patient accounting software and other required applications/systems.
• Must demonstrate detail orientation, critical thinking, and problem solving ability.
• Must demonstrate excellent oral and written communication and customer service skills, with ability to maintain a calm and professional demeanor in high stress situations.
• Must demonstrate ability to work successfully with internal and external customers.
• Demonstrated ability to remain flexible, and consistently exercise sound judgment and initiative in very stressful situations. Ability to effectively manage competing priorities and work independently in a rapidly changing environment.
• Must demonstrate ability to educate, persuade, and negotiate effectively with patients and families.
• Familiarity with state and federal regulations, insurance requirements/guidelines, and hospital, department and Joint Commission policies and procedures (obtained within 1 year of hire and maintained throughout employment).

• Patient Account Management & Education:

  • Customer Support: Assisting patients and other individuals with billing issues, including helping resolve billing problems, explaining payment options, and clarifying insurance coverage, denials, and third-party payment criteria.
  • Education: Educating patients on the resolution of billing matters and available financial resources, such as private pay options, coordination of benefits, and governmental programs.

• Liaison Role:

  • Acting as a liaison between external resources (insurance providers, financial institutions), hospital departments, and patients, ensuring smooth communication and timely resolution of financial matters.

• Financial Collection & Coordination:

  • Data Collection: Coordinating the collection of accurate patient data to verify insurance eligibility and determine the patient’s financial responsibility (copays, deductibles).
  • Payment Negotiation: Effectively negotiating and discussing payment options with patients and families, explaining payment plans, and collecting payments within hospital systems.
  • Processing Payments: Handling payments through electronic systems, processing cash, checks, and credit card transactions, and ensuring security and accuracy in managing the cash drawer and related transactions.

• Financial Assistance Referrals:

  • Financial Assistance: Identifying patients who may qualify for financial assistance, triaging, and initiating referrals to the Patient Financial Services department, completing the necessary paperwork or applications.

• Account Review & Resolution:

  • Account Review: Reviewing and combining multiple financial accounts for a single patient, ensuring all accounts are appropriately processed.
  • Problem Resolution: Investigating and resolving complex issues with patient accounts, identifying problematic trends, and reporting them to management.

• Documentation & Reporting:

  • Accurate Documentation: Logging, noting, and batching accounts following established departmental procedures, and ensuring accurate documentation of patient account activity.
  • Reporting: Sending daily reconciliation reports to the appropriate teams within the hospital’s Finance Department and updating any actions taken regarding payment collection or issues.

• Collaboration Across Departments:

  • Coordinating with Patient Financial Services, Patient Access, Case Management, Scheduling, and clinical departments to ensure consistent financial documentation and a unified approach to patient needs.
  • Ensuring insurance verifications, authorizations, and pre-certifications are obtained for outpatient services when necessary.

• Pre-Registration/Registration:

  • Completing all pre-registration and registration steps, verifying patient identity and demographic information, and ensuring proper collection of health insurance details and eligibility.
  • Distributing Advance Directive information to patients as required.

• Team Collaboration & Cross-Training:

  • Teamwork: Contributing to a positive work environment and supporting the department’s overall goals. May be asked to cross-train other team members or assist in other areas during times of need.

• Miscellaneous Tasks:

  • Records Requests: Coordinating with the Health Information Management (HIM) department to fulfill patient or family requests for medical records.
  • Other Duties: Performing other related tasks as needed by management or the department.

Skills and Competencies Required:

• Strong Interpersonal Skills: Ability to maintain professionalism, patience, and emotional tolerance when dealing with patients, families, and colleagues.

• Knowledge of Healthcare Billing: Understanding of billing processes, insurance coverage, and financial assistance programs, with the ability to explain complex financial information in a patient-friendly manner.

• Problem-Solving & Critical Thinking: Capable of resolving complex issues, researching and troubleshooting billing or account problems, and identifying problematic trends.

• Attention to Detail: Accuracy in documenting all patient interactions and ensuring correct processing of financial information and payments.

• Technical Proficiency: Comfortable using patient accounting and electronic payment systems, as well as understanding hospital computer systems related to job functions.

• Regulatory Knowledge: Understanding of HIPAA compliance, patient rights, and insurance-related regulations.

• Organizational Skills: Ability to prioritize tasks, handle multiple accounts, and ensure the timely resolution of patient financial matters.

This role is integral to both maintaining strong patient relationships and ensuring that the hospital is paid accurately and in a timely manner. The specialist needs to be a skilled communicator, problem solver, and team player.