Patient Financial Services Lead

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 our doors.

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.

The Patient Financial Services (PFS) Lead serves as a liaison for the assigned teams and leadership, and functions as a level of leadership support for each team. This position monitors staff productivity metrics and provides coaching as needed, provides training and schedules shadowing for all new hires during onboarding and afterward, and is expected to be the subject matter expert to support the team. The PFS Lead will attend meetings with and on behalf of leadership, inclusive of internal or external stakeholders, in order to provide feedback, training, and to ensure that the team is aligned with updated processes and takeaways from all meetings. The PFS Lead completes quality claim audits to help ensure staff are moving claims to payment. This position provides oversight on high dollar claims, ensuring accurate and timely claims submission to payers. Oversees claim adjustments submitted by the team, approving or denying after claim review. Collaborates with payers' liaisons to verify processing and payment of claims, resolving aged accounts and escalating claim denials to maximize cash collections. Possesses a higher-level skillset of up-to-date knowledge of payer claim processing rules, reimbursement policies and regulations. Communicates effectively across teams, bringing forward issues or trends to work toward solutions. Supports day to day training, onboarding of new staff and daily needs of team members

Department Name: Patient Financial Services
Job Status: Full time, 40 hours per week.
Shift: 6am to 6pm, Hybrid

• Education: High School Diploma or equivalent required.
• Experience: Minimum five (5) years of healthcare and/or accounts receivable experience.

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. These examples do not include all of the functions which the employee may be expected to perform. * Provides training of all tasks and workflows to all employees on assigned team, including new hires. * Responsible for QA and productivity measures to ensure timely feedback and resolution of escalated accounts. * Reviews team adjustment requests for approval or denial, coaching team as needed. * Acts on behalf of supervisor and/or other leadership when needed, inclusive of acting as on-site leadership coverage with other PFS Leads. * Partners with supervisor and analysts on payer forums, as well as process improvements. * Assists in facilitating meetings with/for supervisor. Holds daily huddles, ensuring that changes and updates are communicated to the team. * Helps create policies and processes for the PFS teams. * Assigns work assignments to the team. * Responsible for outbound calls to insurance for follow-up. * Responsible for updating insurance coverage after claim has been generated and/or updating guarantor/patient demographics. Conducts rudimentary EOB/insurance processing review. * Initiates coding or charge reviews to Research Institute (RI) and Health Information Management (HIM). Has In depth understanding and investigative skills required to review claim segments, Identify modifiers, taxonomy, and NPI concerns. * Sends simple appeals for timely filing, late discovery, other basic denials. Follows up with insurance companies for reprocessing of claims and status of appeals. * Corrects rejected, incomplete, and/or errored claims in Epic and FinThrive. * Handles advanced projects, such as drafting appeals for HMS, LIDS and Ceris Audits. Completes audit process. Sends detailed appeals for LOMN, LOS, other advanced denials. * Identifies trends within payers and escalates as necessary to payers, managed care, or government affairs. * Maintains PFS e-mail box and is the liaison to other departments within CHCO. * Handles escalated payer and patient calls and proficiently discusses accounts, records, and services with patients/families. * Recognizes deviations from contractual expectation and payor activities/decisions, recognizes gaps in payment/reasoning or system errors. * Responsible for trending and analysis - identifying root cause with solution-oriented mindset. Identifies and prioritizes accounts and work queues, based on type, payor, dollar, etc.

SCOPE & LEVEL Guidelines: Guidelines are generally but not always clearly applicable, requiring the employee to exercise judgment in selecting the most pertinent guideline, interpret precedents, adapt standard practices to differing situations, and recommend alternative actions in situations without precedent. Complexity: Duties assigned are generally complex and may be of substantial intricacy. Work assignment is performed within an established framework under general instructions but requires simultaneous coordination of assigned functions or projects in various stages of completion. Decision Making: Exercises judgment and discretion, and is responsible for determining the time, place and sequence of the work performed. Communications: Contacts with team members, clients or the public where explanatory or interpretive information is exchanged, defended, and gathered and discretion and judgment are required within the parameters of the job function. Supervision Received: Performs work with minimal supervisory oversight. Under general supervision, the employee receives assignments and is expected to carry them through to completion with substantial independence. Work is reviewed for adherence to instructions, accuracy, completeness, and conformance to standard practice or precedent. Recurring work clearly covered by guidelines may or may not be reviewed.

Ability to Perform Essential Functions of the Job

PHYSICAL REQUIREMENTS Audio-Visual: Hearing: Good Audio-Visual: Near Vision: Good General Activity: Sit: Up to 2/3 of tim Motion: Bend: Up to 1/3 of time Use of Hands/Feet: Precise Motor Function Weight Lifted/Force Exerted: Up to 30 pounds WORK ENVIRONMENT Mental and Emotional Requirements: Independent discretion/decision making. Mental and Emotional Requirements: Makes decisions under pressure. Mental and Emotional Requirements: Manages stress appropriately. Mental and Emotional Requirements: Works with others effectively

It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information.

The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of attendance at or graduation from an educational institution. You will not be penalized for redacting or removing this information.

Here, you matter. As a Children's Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career.

As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children's Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.