Job Code: 07308-1769
The Ambulatory Surgery Division operates over 100 ambulatory surgery centers’ across the U.S. Ambulatory Surgery Centers (ASCs) perform surgeries that do not require hospital admission. They provide cost-effective services and a convenient environment. Procedures are performed in a fully equipped operating room and recovery is under the care of highly skilled nurses. Whether young or old or somewhere in between, patients and their families benefit from the comfortable environment ASCs have to offer. Surgeries performed include eye, ear, nose and throat (ENT), general surgery, gynecologic, plastic surgery, podiatry and orthopedics. Apply Now! Come Join our Team!
GENERAL SUMMARY OF DUTIES: Contributes to the company by handling various business office functions, including: billing, cash posting, chart preparation, cash posting, collections, insurance verification, medical records, patient registration, and scheduling.
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
- Responsible for accurately performing all functions of patient admissions, including reviewing all information with patient, completing appropriate forms, and copying appropriate insurance cards and photo identification.
- Insurance Verification:
- Performs insurance pre-certification, verification, and interviews patients prior to surgery and documents information accordingly.
- Verifies and obtains all patient eligibility, authorizations, benefits, and claim information with insurance companies or 3rd party payer at least within 3 business days prior to surgery.
- Determines and documents patient portions due, amounts to be billed, contractual discounts to be taken, or any other authorized discounts that may apply. Communicates this information with appropriate personnel for preparation of the pre-admission process. Also communicates with appropriate personnel any problems arising with the verification of benefits.
- Identifies all patient accounts accurately based on what PPO, HMO, or other Managed Care Organizations the patient’s insurance plan might fall under.
- Contacts patients and provides updates on benefit verification information, requests additional information, insurance cards, and explains to the patient his or her financial responsibility such as co-pays, co-insurance, co-deductibles, at time of service.
- Accurately completes data entry necessary including authorizations and benefits as well as patient communication in the appropriate module of Advantx.
- Makes financial arrangements after consulting with CBO Director/BOM when patient is unable to pay amounts due in full the day of surgery.
- Notifies CBO Director/BOM of any insurance carrier information changes.
- Works all identified insurance requirement edits through AdvantX.
- Reviews the insurance contract profiles in AdvantX to ensure the system is making appropriate adjustments based on the procedure and type of reimbursement.
- Works with electronic billing vendor to resolve any e-billing issues, denied claims, etc.
- Generates and processes all insurance claims.
- Researches required information and maintains pending follow up on a daily/weekly basis.
- Communicates daily information needed for billing.
- Prints appropriate billing forms and forwards them to the insurance carrier.
- Prints statements to patients for balances due, and if information is available, bills secondary Insurance carrier.
- Inputs charges to create claims in AdvantX.
- Sends electronic insurance claims to clearinghouse (GHN).
- Reconciles Batch report and Billed insurance report.
- Reconciles Billed insurance report with GHN Batch report.
- Maintains daily tasks with GHN current.
- Reviews GHN online errors. Makes appropriate corrections and resubmits claims.
- Reviews GHN messages and updates BOM if needed.
- Maintains weekly error log and Non-Covered Procedure logs. Submits log to Registration supervisor for review.
- 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.
- Schedules patient surgical procedures and maintaining the surgery schedule.
- Serves as back up for business office positions when needed.
- Assists other employees when time allows and completes other duties as assigned.
- Performs routine clerical and administrative functions, including answering incoming phone calls.
KNOWLEDGE, SKILLS & ABILITIES:
- Organization – Proactively prioritizes 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 long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
- Decision Making – Identifies 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, and 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.
EXPERIENCE: Minimum (2) years of experience in a medical office setting highly preferred. (i.e. ambulatory surgery center, hospital, doctors office).
CERTIFICATE/LICENSE: Basic Life Support (BLS) may be required as determined by facility practices.
Last Edited: 05/01/2017