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Job Summary
Responsible for patient registration, precertification, charge capture and coding diagnoses given by physicians. Receives and interviews patients to collect and verify pertinent demographic and financial data. Verifies insurance and initiates pre-authorization process when required. Responsible for posting all payments and balancing with the computer reports at day end. Arranges for patient pre-payments and enforces financial agreements prior to providing service. Works queues, when appropriate gathers charge information, codes, enters into EHR, completes billing process, distributes billing information. Files insurance claims and assists patients in completing insurance forms. Processes unpaid accounts by contacting patients and third-party payers. Can assume decision making responsibilities as directed by manager.
Essential Functions
- All team members are expected to be knowledgeable and compliant with Prisma Health’s values of compassion, dignity, excellence, integrity and teamwork.
- PATIENT ACCOUNTING/REGISTRATION/SCHEDULING:
- Interviews patient or other source (in accordance with HIPAA Guidelines) to secure information relative to financial status, demographic data and employment information. Enters accurate information into computer database, accesses appropriate systems to ensure the most recent insurance card is on file, and scans documents according to departmental guidelines. Follows up for incomplete and missing information.
- Serves as a liaison between patient and medical support staff.
- Greets patients and visitors in a prompt, courteous, and helpful manner.
- Checks in patients, verifies and updates necessary insurance information in the patient accounting system (online Registration).
- Obtains signatures on all forms and documents as required.
- Maintains office schedule and follows office scheduling policies.
- Provides front office phone support as needed and outlined through cross training program.
- Screens visitors and responds to routine requests for information.
- Responsible for working work queues to completion, i.e. registration, charges, referrals, etc.
- Processes vouchers and private payments, to include updating registration screens based on information on checks.
- Helps to process mail return statements and outgoing statements.
- Reconciles and acquires, when needed, billing information for all doctors for all patients seen in practice.
- Performs cashiering functions including monitoring and balancing cash drawer daily. Prepares daily cash deposits. Receives payments from patients and issues receipts. Codes and posts payments and maintains required records, reports and files.
- Works with patients in securing prepayment sources or financial agreements prior to providing service.
- Participates with other staff to achieve account resolution. Assists with outpatient coding and error resolution.
- Processes edits and Collection Request for resolution within specified time frames.
- Identifies trends and communicates problems to management.
- Updates patient account database.
- Maintains and updates current information on physician's schedules.
- Schedules surgeries, ancillary services and follow-up outpatient appointments and admissions as requested.
- Assembles patients records and forms for next day visit. Updates profiles on all patients, ensuring completeness and accuracy.
- Prepares and distributes appropriate reports, documents, and patient identification items as required. This includes but is not limited to, GHS Privacy Notice, Patient Rights and Responsibilities, Patient Rights in Healthcare Decisions Brochure, schedules, productivity logs, monthly collection reports, etc.
- BILLING:
- Research all information needed to complete outpatient billing process including getting charge information from physicians.
- Codes information about procedures performed and diagnosis on charge.
- Keys charge information into on-line entry program.
- Processes and distributes copies of documents according to clinic policies.
- Assists with outpatient coding and error resolution.
- Reviews patient records for scheduled appointments in advance.
- Delivers, transports, sorts and files returned charts.
- Picks up lab reports, dictations, correspondence, etc.
- Scans appropriate information into the EHR.
- Destroys outdated records following established procedures for retention and destruction.
- Works with medical assistants and other staff to route patients and records to proper location.
- Follows related EHR policies and procedures.
- INSURANCE:
- Assists patients with questions regarding insurance claims, their accounts, obtaining disability insurance benefits, home health care, medical equipment, surgical care, etc.
- Processes benefit correspondence, signature, and insurance forms to expedite payment of outstanding claims.
- Assists patients in completing all necessary forms to obtain hospitalization or Surgical precertification from insurance companies, including waivers for cases where pre-certification is required but not yet obtained.
- Follows-up with insurance companies ensuring that coverage is approved.
- Posts all actions and maintains permanent record of patient accounts.
- Confirms all workers' compensation claims with employees.
- Prepares disability claims in a timely manner.
- Follows-up with insurance companies ensuring that claims are paid as directed.
- COLLECTIONS:
- Collects payments at time of service for daily outpatient visit services.
- Evaluates patient financial status and establishes budget payment plans.
- Identifies and resolves patient billing complaints.
- Participates with other staff to follow up on accounts until zero balance or turned over to collection.
- DATA ENTRY:
- Gathers and verifies information for specified practice on a daily basis.
- Enters all same day payment information for patient visits and hospital patients, verifying accuracy of coding, charging and patient insurance status.
- Prints daily reports, verifying charge balancing at day end.
- Complete work queues on daily basis.
- Registers new patients after verifying patient status on computer inquiry. Updates financial information as indicated.
- Performs other duties as assigned.
Supervisory/Management Responsibilities
- This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
- Education - High School diploma or equivalent. Associate degree in a technical specialty program of 18 months minimum in length preferred.
- Experience - Two (2) years in billing, bookkeeping, scheduling and/or office procedure experience with medical insurance in a physician practice, hospital or medical insurance processing work environment.
In Lieu Of
- Bachelor's degree in Healthcare or Business and one (1) year experience may be acceptable.
Required Certifications, Registrations, Licenses
Knowledge, Skills and Abilities
- Excellent interpersonal skills
- Multi-specialty group practice setting experience - Preferred
- Intermediate ICD-9 and CPT coding abilities - Preferred
Work Shift
Day (United States of America)
Location
Patewood Memorial Hospital
Facility
1046 Patewood Hospital
Department
10457822 Surgery-Vascular-IVH
Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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