Job Abstract

Specific daily duties are assigned in accordance with the needs of the Business Office operations.

· Handles various business office duties that may include billing, cash posting, chart preparation, cash posting, collections, insurance verification, medical records, patient registration, scheduling and other assigned duties.

· Billing:

o Works all identified insurance requirement edits through AdvantX.

o Reviews the insurance contract profiles in AdvantX to ensure the system is making appropriate adjustments based on the procedure and type of reimbursement.

o Works with electronic billing vendor to resolve any e-billing issues, denied claims, etc.

o Generates and processes all insurance claims.

o Researches required information and maintains pending follow up on a daily/weekly basis.

o Communicates daily information needed for billing.

o Prints appropriate billing forms and forwards them to the insurance carrier.

o Prints statements to patients for balances due, and if information is available, bills secondary Insurance carrier.

o Inputs charges to create claims in AdvantX.

o Sends electronic insurance claims to clearinghouse (GHN).

o Reconciles Batch report and Billed insurance report.

o Reconciles Billed insurance report with GHN Batch report.

o Maintains daily tasks with GHN current.

o Reviews GHN online errors. Makes appropriate corrections and resubmits claims.

o Reviews GHN messages and updates BOM if needed.

o Maintains weekly error log and Non-Covered Procedure logs. Submits log to Registration supervisor for review.

· Collections:

· Performs follow up activities timely on all accounts to ensure prompt payment.

· Maintains daily queue on desktop.

· Identifies coding or billing problems from EOBs and works to correct the errors in a timely manner.

· Prepares accounts for rebilling and for filing secondary insurance; sends to carrier with necessary documents, as needed.

· Completes filing and follow-up on insurance denials with coder and physicians to obtain reimbursement.

· Updates the patient account record to identify actions taken on the account.

· Updates AdvantX using daypack and re-files claims, as required.

· Assigns Bad Debt accounts to Collection Agency as approved by BOM.

· Completes the reconciliation of accounts that are turned over to outside agencies.

· Notifies BOM/Administrator of contractual issues that are contrary or inconsistent with contract language.

· Negotiates payment plans on self pay accounts utilizing established policies regarding Settlement Discounts.

· Responsible for achieving and maintaining accounts receivable days at the established ASD goal.

· Responsible for the reduction and maintenance of bad debt at the established ASD goal.

· Follows Best Practices regarding initial follow-up/first contact at 21- 28 days for insurance claims and subsequent follow-up every 14-21 days.

• Scheduling:
• Schedules patient surgical procedures and maintaining the surgery schedule.
• Medical Record:

o Manage the medical records of a healthcare facility

o Sort, organize and scan patient files by name or by number for easy retrieval and updating

o Performing data entry tasks

o Updating existing records

o Maintaining company archives

o Retrieving information from the filing system when requested

· AP:

o Code invoices, match PO and delivery confirmation

o Responsible for processing all the invoices for a company and processing all payments

o Identify discrepancies and resolve billing issues

o Handling expense reports

o Providing financial, administrative and clerical support to the organization.

o Compile and present necessary reports

o Continuously improve payment processes

· Serves as back up for business office positions when needed.

· Assists other employees when time allows and completes other duties as assigned.

· Other duties as assigned based on business operational needs.

Minimum (2) years of experience in a medical office setting highly preferred. (i.e. ambulatory surgery center, hospital, doctors office) preferred.

· Organization – Proactively prioritizes needs and effectively manages resources and time.

· Communication – Communicates clearly, concisely and professionally.

· Analytical Skills – Demonstrates ability to critically evaluate and appropriately act upon information.

· Customer Orientation – Establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.

· Decision Making – Identifies and understands issues, problems, and opportunities; compares data from different sources to draw conclusions; uses effective approaches for choosing a course of action or develops appropriate solutions; takes action that is consistent with available facts, constraints, and probable consequences.

· Contributing to Team Success – Actively participates as a member of the Center’s team to move the team toward the completion of goals.

· Policies & Procedures – Articulates knowledge and understanding of organizational policies, procedures, and systems.

· PC Skills – Demonstrates proficiency in Microsoft Office (Excel, Word, Outlook) applications; knowledge of, or ability to learn, AdvantX – Accounts Receivable System, Smart, HOST and other systems as required. Demonstrates ability to type on PC keyboard.

· Technical Skills – Demonstrates a basic knowledge of medical terminology and medical insurance.