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) Specialist supports various programs within the Patient Financial Services Department. This position supports advanced department administrative functions and provides high level customer service to both internal and external customers. The PFS Specialist works directly with leaders within PFS providing direct program support by root cause analysis and is responsible for quality control for Revenue Cycle, as well as process improvement. This position requires possession of a higher-level skillset and up-to-date knowledge of payer claim processing rules, reimbursement policies and regulations to partner with appropriate teams for support, attends meetings with leadership and other departments providing feedback and takeaways to the department that they support to ensure that the patient financial teams are aligned with any updated processes.

Department Name:
Job Status: Full time, 40 hours per week
Shift: Monday to Firday 8am to 5pm, 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.
* Responsible for outbound calls to insurance for follow-up.
* Handles EDI management and PFS enrollments.
* Responsible for CAS Ticket and Vendor management. * Credit card conversion (HB and PB) with Echo, Zelis and Vpay.
* Responsible for updating insurance coverage after claim has been generated and/or guarantor/patient demographics.
* Completes payer audit requests (primarily or partners with primary) in a timely and efficient manner.
* Liaison with vendors to ensure PFS needs are being met and quality relationships continue.
* Develops the quality and patient escalations program for patient experience and conducts reviews with staff to ensure patient satisfaction/resolutions.
* Corrects rejected, incomplete and errored claims in Epic and the clearinghouse vendor. Sends simple appeals for timely filing, late discovery, other basic denials.
* Conducts EOB/Insurance processing reviews, coverage change, and other advanced insurance activities. * Management of the Clearinghouse, including attending meetings, app management, creating logins, groups, adding providers to the Pro Table, and monitoring rejections. * Full understanding of contract summaries to advise correct applications for an account. * Handles Experian cases as needed for Dental EDI.
* Maintains PFS e-mail box and is the liaison to other departments within CHCO.
* Handles escalated payer and patient calls and proficiently discuss accounts, records, and services with patients/families.
* Works all assigned work queues in a timely manner.
* Ability to recognize 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.
* Ability to identify and prioritize accounts and WQs, based on type, payor, dollar, etc.
* Has in depth understanding and investigative skills required to review claim segments, identify modifiers, taxonomy, NPI, and other billing issues or concerns.
* Has advanced understanding of account types in their entirety, including inpatient & outpatient hospital, therapies, lab and clinic locations to support across CHCO's system.
* Ability to handle multiple EMR platforms and provide "full service" account details to patients.

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 time
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.

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.