Employment Type:

Shift:

Description:

POSITION PURPOSE

Under general supervision, performs various duties including but not limited to: registration of patients, obtains insurance information, identifies the need for and obtains authorizations and recertifications from insurance carriers and physicians offices. Verifies assignments of patient benefits, co-pays and self- responsible portion of charges and collects same. Balances daily transactions at the close of each day and handles cash deposits according to established procedures. Codes charges in conjunction with physician and with guidance from the MPC Coding Specialist using ICD-9 and CPT4 coding manuals. Enters all in-office and out-of-office charges into computerized patient management system. Processes managed care referrals to specialists and or ancillary services. Schedules patient appointments as directed by physicians. Must be knowledgeable of managed care plans and the associated plan requirements. Possess working knowledge of capitated charges versus fee-for-service charges. Assures that accurate and timely revenue capture is performed at the practice site. Emphasis of this position is on revenue capture and day-end balancing and deposits. This emphasis differentiates this position from the MPBA I.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

1. Enters and updates patient demographic information for every charge entered. Obtains and enters insurance coverage for every charge. Utilizes appropriate information i.e. computerized insurance address dictionaries and coverage code dictionaries. Notes effective date of coverage in computer if appropriate. Identifies the need for pre-authorization, pre-certification and referral and initiates the process. Performs, if systems available, secondary review of patient insurance information utilizes Caren, Vera and other insurance sources to assure eligibility and benefits and make assignment if necessary. Assures that charges are correctly entered as capitated versus fee-for-service. Seeks to optimize revenues through accurate capture of non-capped services. Develops system to track and perform charge entry of services performed by providers outside of the office setting, e.g. hospital admissions, consultations, deliveries, surgeries, etc.

2. Determines patient balances (co-pays) both present and past at the time of service. Communicates these to the patient, collecting balances. Posts payments to the system. Reviews billing/insurance questions and problems with the patient, guarantor, insurance plan and CBO. If unable to resolve issue, refers to appropriate personnel. Identifies patients requiring financial assistance and facilitates referral for McAuley Support according to department policy.

3. Enters all appropriate charges for all office visits, procedures, hospital visits, surgeries and nursing home visits. Utilizing ICDSCM diagnosis coding and appropriate matching of codes to procedures. Uses pricing modifier place of service codes, referral codes and authorization numbers as needed.

4. Responsible for transaction balancing at the close of each day. Balances cash, checks and charge payments to the system following guidelines established by the Central HSC Billing Office. Prepares, balances and transports bank deposits.

5. Schedules and coordinates provider appointments and procedures for all office providers exercising appropriate triage techniques related to patient acuity. Prints and reviews daily appointment schedule and routers for accuracy, patient access and availability of medical record. Arranges for hospital admissions including recertifications.

6. Receives and evaluates incoming telephone calls according to Best Practice Model and SJMHS customer service standards. Involves physician/providers as appropriate to assure patient triage protocols are followed.

7. Compiles or retrieves medical record for visit with Provider. Reviews for accuracy of patient information including authorization signature making necessary corrections. Inserts necessary forms and loose filing. Completes chart audits and maintains filing system and records in compliance with state and federal law, third party payers and departmental requirements. Files medical records, dictation notes, test results and other patient related correspondence.

8. Performs a variety of clerical duties such as typing, mail processing, ordering and maintenance of supplies. Send reminders/information/forms to patients, guarantor, insurance companies and government agencies.

9. Complies with mandatory attendance to meetings, workshops, in-services as required by department such as ICD-9, CPT4 coding, computer classes, insurance information and customer relation skills. Implements recommendations of Coding Specialist and Quality Coordinator.

10. Assists physician/provider and clinical support staff by escorting patients and performing other duties as assigned in order to expedite patient through- put.

11. Performs all other duties and projects as assigned.

12. Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps identify problems, offer solutions and participate in their resolution.

13. Maintains the confidentiality of information acquired pertaining to patient, physicians, employees and visitors to SJMHS. Discusses patient and hospital information only among appropriate personnel in appropriate private places.

14. Behaves in accordance with the Mission, Vision and Values of St. Joseph Mercy Health System.

15. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.

16. Knowledgeable of age-specific needs of patients following appropriate guidelines.

OTHER FUNCTIONS AND RESPONSIBILITIES

Performs other duties as assigned.

REQUIRED EDUCATION, EXPERIENCE AND CERTIFICATION/LICENSURE

1 Required: One year experience in physician office setting performing comparable duties or one year experience in a billing position. Knowledge in ICD-9 and CPT4 coding. Knowledge of third party payers and managed care guidelines. Required experience is subject to be waved when deemed appropriate.

2 Preferred: Experience with a computerized patient management system. Experience with online third party payer systems. Experience on business machines such as: FAX machines, multi-line telephones, copy machines, and computers.

REQUIRED SKILLS AND ABILITIES

1. Effective oral communication skills.

2. Ability to type 35 w.p.m. and/or computer keyboard efficiency

3. Basic math skills required for counting/balancing money and charges.

4. Must satisfactorily complete central billing offices' training program.

5. Ability to work under pressure and to consistently prioritize multiple tasks (demonstrates adaptability/flexibility

6. Ability to concentrate and pay close attention to detail while performing tasks.

7. Ability to demonstrate poise during stressful situations.

8. Has the skill and desire to work as a team member

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.