Company Overview Spectrum Healthcare Partnersis Maine’s largest multi-specialty, physician-owned and directed professional organization and is comprised of over 200 physicians practicing in the areas of anesthesiology, orthopaedics, pain management, pathology, radiation oncology, radiology, and vascular & interventional services. Spectrum provides services at many of Maine’s hospitals throughout the state and in eastern New Hampshire. POSITION SUMMARY The Lead Patient Financial Specialist serves as Subject Matter Expert (SME) for patient self-pay policies, time of service payment processing, insurance benefits/eligibility, bad debt collection and their workflows in the practice management system and other technology such as patient portal, phone system and payment processing sites. Functions as the primary trainer for new and existing staff in all Spectrum Orthopaedic locations including outside contracted partners for self-pay policies and workflows. Responsible for making sure responses are timely to patient and internal staff questions while ensuring an excellent customer experience whether in person, on the telephone, via email, through the patient portal or from tasks in both the practice management and electronic health record work logs. HOURS: M-F, 8:00AM - 4:30 PM. 2 or more years experience in healthcare revenue cycle customer service, patient access, financial counseling, billing or collection. ESSENTIAL FUNCTIONS
Serves as the subject matter expert for self-pay accounts receivable workflows and processes, price estimates, insurance benefits/eligibility, waivers, and provider portals.
Under the direction of the Revenue Cycle Manager, coordinates, motivates and directs workflow of the Patient Financial Specialist team.
Is the Patient Financial Specialist team primary trainer for time-of-service collection, price estimates, surgical deposits, non-covered service waivers/ABNs and patient billing and bad debt related workflows.
Serves as a resource to all practice locations for financial, billing, eligibility and patient statement questions/concerns.
Handles escalated customer complaints or questions. Involves manager or clinical leaders as needed.
Monitors daily patient and staff financial questions queues/worklogs via phone, task, TEAMS chat, email, patient portal and coordinates responses in a manner to ensure optimal patient experience.
Monitors daily self-pay accounts receivable activities and provides guidance, direction, and support to staff as priorities change.
Pursues appropriate and complete collections from accounts receivables due from patients by proactively meeting with uninsured patients, connecting with patients about outstanding balances and collecting pre-payments from patients (including those with high deductibles or non-covered services) before services are rendered.
Explains to our patients the expectations outlines in the organization's financial protocols/policies.
Works with other Orthopaedic leads to ensure system optimization, excellent customer service and key performance metrics are achieved.
Works closely with other Revenue Cycle staff to promptly address any practice management or payment site issues affecting patients.
Provides input to Patient Access Manager and Revenue Cycle Manager on staff performance, training needs, system optimization, etc.
With direction from revenue cycle leaders, develops, implements, and maintains self-pay accounts receivable workflows, protocols, policies, and procedures
Resource and internal expert for patient payment portal. Assists in training and identifies opportunities for improvements in patient experience.
Daily problem solving and complex issue/dispute resolution
Complies with the requirements of the Fair Debt Collection Practices Act, Patient Friendly best practice billing guidance, Regulation F, No Surprises Act and other regulatory requirements related to collection of patient balances.
Complies with the philosophy of Spectrum Healthcare Partners to collect patient balances through personal contact with patient/guarantor without disrupting the provider patient relationship
Maintains working knowledge of billing workflows, processes, and overall insurance accounts receivable
Ensures departmental and practice protocols are followed, identifies, and conducts training as needed. Works with and regularly communicates this information to the Revenue Cycle Manager
Strives to maintain positive patient relations by handling problems and complains in a professional, confidential manner
Travels to all Orthopaedic practice locations as needed for training
PRIMARY RESPONSIBILITIES
Coordinates financial specialist team in daily activities
Responsible for financially clearing uninsured patients and patients with prior bad debt to receive services
Accurately calculates and collects payments for uninsured patients and non-covered services before services are rendered
Accurately prepare estimates for patients. Abiding by the timeframes in the No Surprises Act for delivering uninsured Good Faith Estimates
Proactively works with patients to implement a payment plan on anticipated outstanding balances
Records and maintains complete documentation of activities performed on account utilizing account notes
Manages outstanding self-pay balances in the Account Collections queues according to the organization’s standards to effectively exhaust all possibility of in-house collection
Uses knowledge of insurance reimbursement to ensure that services have processed through insurance and payments have been posted correctly, working closely with Accounts Receivable staff when necessary
Performs accurate daily payment batch reconciliation
Assists with data gathering for financial reporting
Keeps abreast of current issues involving patient care or practice issues by attending and participating in department, team, and practice meetings
Resolves conflicts among staff through open and direct communications
Performs quality review of the teams completed work to monitor accuracy
Provides input to Revenue Cycle Manager to complete employee evaluations in a timely manner
Demonstrates professionalism always
Displays cooperative behavior and interacts positively and effectively with others to promote a team environment
Performs other duties necessary to maintain the overall efficiency and continuity of the clinic
Is proactive in identifying, reporting, and participating in the resolution of any potential or actual patient safety issues
Support the Company’s Vision and Values
QUALIFICATIONS
High school graduate or high school equivalency credential; Associates degree preferred
2 years or more experience in healthcare revenue cycle, finance, revenue cycle or customer service or other related healthcare role/field
Health care insurance claims follow up and/or insurance provider portal benefits review experience helpful and preferred. Understanding of healthcare collection protocols helpful.
Excellent customer service skills
Attention to detail
Excellent communication, organizational and interpersonal skills
Ability to make well-reasoned decisions, both independently and as part of a team
Ability to follow-through to meet patient, physician, and/or practice needs
Ability to use discretion in handling confidential information; Ability to maintain confidentiality
Ability to work independently and as part of a team; Ability to work collaboratively and effectively with individuals at all levels of the organization
Proficient computer skills including email, Outlook, Microsoft Word, Excel and MS Office 365 Teams.
Prior experience with practice management systems preferred.
PHYSICAL DEMANDS / WORK ENVIRONMENT
Operation of various office equipment; fax machine, telephone & voice mail system, stationary/lap top computer, scanner, e-mail system, cell phone, pager, and copier
Light lifting of paperwork, folders or other general record keeping materials
Lifting of mail bins and boxes up to 50 lbs.
Regular travel to various sites of service
May be required to sit or stand for extended periods of time
Occasional reaching, bending
Benefits and Perks
Health Insurance (80% company paid)
HSA Match ($3,000 family plan / $1625 individual plan)
Dental & Vision Insurance Plans
401(k) Match and Profit Sharing Plan
Life and Accidental Death and Dismemberment Insurance
Long-term Disability Insurance
Short-term Disability Insurance
Generous paid time off
Voluntary, Employee-Paid Benefits
Medical Reimbursement Plan
Dependent Care Plan
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