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Job ID91585

LocationAurora, Colorado

Full/Part TimeFull-Time

Regular/TemporaryRegular

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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) 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 an

Additional Information

Department Name: Patient Financial Services Job Status: Full time, 40 hours per week. Shift: 6am to 6pm, 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. These examples do not include all of the functions which the employee may be expected to perform. * Provide 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