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Sr Patient Financial Services Analyst

Sr Patient Financial Services Analyst

Job Code

30001428

 

Basic Function

To support Patient Financial Services Manager in the Patient Financial Services department of the Johns Hopkins Aramco Healthcare (JHAH) Finance Department. To execute activities across Accounts Receivable analytics and reporting, and internal controls.

Scope

To support Patient Financial Services Manager in the Patient Financial Services department of the Johns Hopkins Aramco Healthcare (JHAH) Finance Department. To execute activities across Accounts Receivable analytics and reporting, and internal controls.

Principal Contacts

Report to:

  • Patient Financial Services Director and Patient Financial Services Manager

Interact with:

  • Relevant internal and external stakeholders (Population Health, Physicians, Nursing, Information Technology, Legal, Human Resources, Patients)
  • JHAH Finance (Financial Controller, Financial Planning & Analysis Director, Finance team)
  • Revenue Cycle Management teams across Johns Hopkins International (JHI)

Principal Duties

a) Receivables management:

Charge Entry:

Receives and reviews charge documents from the clinic or charge router. Ensures charge information provided is correct and accurate. Review and retain hospital records in order to compute fees and charges due. Balances Charge Summary to charge router workflows before updating charges. Contact customers in order to obtain or relay account information. Enters charges in a timely manner in a high volume setting. Research and verify accuracy of billing data and revise any errors including adjustments and denials. Keeps supervisor apprised of matters regarding charge entry

Billing:

Reviews all claims and statements within designated alpha and discipline before release. Attaches required documentation to claims for payments. Assists customers with billing questions. Researches and corrects all denials received for designated alpha and discipline. Documents all correspondence with patients, insurance carriers, and vendors. Other responsibilities as assigned.

Collector:

Identifies delinquent accounts, aging period, and payment sources. Processes delinquent unpaid accounts by contacting patients and third-party payers. Reviews accounts, credit reports, and other information sources such as credit bureaus via computer. Performs various collection actions including contacting patients by phone and resubmitting claims to third-party payers. Evaluates patient financial status and establishes budget payment plans. Follows and reports status of delinquent accounts. Reviews accounts for possible assignment; makes recommendations to credit manager and prepares information for collection agency. Assigns uncollectible accounts to collection agency or attorney via clinic credit and collection policy. Contacts lawyers involved in third-party litigation. Assist in providing PFS management with information and recommendations regarding receivable and / or unit performance.

Payment  Posting:

Responsible for posting all payments, adjustments and denials from all forms of insurance payment to the appropriate claim. Responsible for posting of all patient payments received in mail or wire transfer payments. Send for review all zero riyals, denials and underpaid amounts. Makes line item adjustments, as directed, for all zero pays and denials. Identify accounts that need to be refunded. Ensure correct payment processing. Close batches in system at end of the day. Run and analyze balancing report to ensure accurate posting. Completes all tasks received via the JHAH Epic dashboard, daily. Scan all explanation of benefits into electronic chart. Answer questions from business office staff, providers, and supervisors regarding payment posting, or the explanation of benefits. Understands coordination of benefits and payer responsibility. Ability to understand explanation of benefits and recognize underpayments.

Reporting

Oversee analysis of changes in receivable balances, aging, and components from prior periods; develop explanations for variances. Secure development and preparation of concise monthly management reports to summarize collection performance. Assist in calculation of reserve requirements to validate JHAH accounting estimates.

b) Policies and procedures: Prepare and maintain JHAH’s financial policies and procedures based on best practices applicable to the healthcare industry

c) Other responsibilities: Support development of plans for ad-hoc projects and manage project team activities to achieve given targets

Education

Bachelor’s Degree in Accounting, Finance or equivalent 

Experience

  • Minimum 10 years of varied experience in a hospital environment
  • Knowledge of third party billing and collection processes, with particular focus on billing requirements, contractual arrangements, utilization review guidelines and certification / authorization processes for both institutional and professional fees
  • Knowledge of accounting principles that directly impact the Accounts Receivable, including debit and credit transactions, charge transfers, contractual allowances and adjustments, financial class changes and revenue reclassification, and reserve methodology and mechanics
  • Knowledge in charge master development for hospital
  • Knowledge of hospital operations and patient flow so as to be able to identify and analyze potential sources of errors or patient dissatisfaction and reflect these changes on the policies, procedures and processes
  • Knowledge of revenue cycle systems and methodologies to improve level of automation
  • Knowledge of the Ministry of Health (MOH), GOSI and of the Council of Cooperative Health Insurance (CCHI) regulatory environment so as to ensure compliance with regulations regarding patient and insurance billing issues
  • Knowledge of CPT coding and ICD10 CM & AM coding
  • Knowledge of technology alternatives applicable to the patient accounting environment – i.e., optical imaging, call center processing, collector workstation
  • Understanding of medical terminology

Certifications/Other requirements as applicable

  • Fluency in both written and spoken Arabic and English
  • Relevant computer skills (MS Office, ERP systems)
  • Strong oral and written communication skills
  • Excellent analytical thinking
  • Autonomy

Competencies

3. Communicate Openly & Effectively
6. Plan & Organize Work
2. Quantity Of Work
5. Foster Teamwork
1. Person-Centered Care
4. Drive For Results
7. Cybersecurity