Description
Expected Starting Salary Range: 22.79 - 27.77
SUBFUNCTION DEFINITION: Prepares and forwards patient claims to appropriate third-party payers. Analyzes and reviews claims to ensure that payer-specific billing requirements are met. Follows up on billing, determines and applies appropriate adjustments, answers inquiries and updates accounts as necessary.
POSITION TITLE: Financial SpecialistSUBFUNCTION DEFINITION: Prepares and forwards patient claims to appropriate third-party payers. Analyzes and reviews claims to ensure that payer-specific billing requirements are met. Follows up on billing; determines and applies appropriate adjustments; answers inquiries and updates accounts as necessary.CAREER LEVEL SUMMARY: Requires full proficiency through job related training and considerable on-the-job experience to perform range of tasks. Works under limited supervision for routine situations. Non-routine problems are solved by applying precedents and existing processes to new situations. Identifies key issues and patterns from partial/conflicting data. May act as an informal resource for colleague with less experience.
REPRESENTATIVE RESPONSIBILITIES

• Quality

May perform research and analysis. Participate in departmental/division performance improvement and quality assurance controls. May perform account audits and develop and execute corrective actions plans. Participate in LEAN Collaboratives and partner with the clinic team to research and solve systemic problems.

• Billing

Compile and prepare patient charges. Prepare invoices billings, UB-04 and 1500 claim forms to be sent to 3rd party payers for payment indicating individual line items for services and total costs. Review charges. Obtain and evaluate family, third party payers and agency resources for payment of charges. Managing patient billing and ensure procedures are billed according to contracts, transmit or mail all paper and claims, and review correspondence and follow up as needed. Ensure insurance verification of benefits, eligibility and plan participation. Secure authorizations with supporting documentation as needed. Communicate with families on coverage and out-of-pocket liability. Process insurance changes.

• Financial Responsibility

May have specialized areas of responsibility (e.g. government & non-government billing, appeal processing, review & approval of refunds in addition to coding corrections, etc.). May manage specialized work queues independently due to knowledge and unique system security clearance.

• System Support

Identify system and technology needs. Participate in advancing use of technology. Ensures systems meet all regulatory and compliance requirements. Perform tasks which require higher level of security access. May lead in testing, install updates and act as the liaison with the vendor to make appropriate programming changes and solve systems issues.

• Collaboration

Perform duties in support of team members' daily operations, problem solving, projects, and communications with payor representatives. Supplement training beyond training on services, systems and payor specifics. Perform specialty services functions and may direct daily activities for specific work functions. Act as a resource within the department/division. Provide instruction for performing non-routine functions. Serve as a liaison between Billing and Coding Services, Admitting, Outpatient Surgery, Outpatient Department, and other Cincinnati Children's departments. May have supervisory responsibilities.
Qualifications
EDUCATION/EXPERIENCE
Required:

• High school diploma or equivalent
• 3 to 5 years related experience

Preferred:

• Bachelor's degree
• Coding certification
• 2 years related experience in healthcare system revenue cycle settings

Unique Skills:

• Prioritization

Using time efficiently and productively; prioritizing multiple tasks properly to meet deadlines; recognizing time constraints and adjusting work schedule to address them.

• Knowledge of Field - Intrm

Knowledge of regulations, procedures and best practices in field

• Systems - Basic

Working knowledge of systems relevant to the field

• Detail Orientation

Meticulously keeping track of details without becoming overwhelmed by them; being exacting, precise, and accurate; spotting minor imperfections or errors and taking action to correct them

• Professional Demeanor

Demonstrates an independent work initiative, sound judgment, diplomacy, tact and professional demeanor

• Problem Solving

Ability to independently work through details of a problem to reach a positive solution

• Communication

Excellent verbal, written and/or interpersonal communication skills

• Preferred

Training and/or experience in databases and Microsoft applications
Cincinnati Children's is proud to be an Equal Opportunity Employer that values and treasures Diversity, Equity, and Inclusion. We are committed to creating an environment of dignity and respect for all our employees, patients, and families (EEO/AA).