Business Office Specialist II - FT - Days - Billing and Collections
This position is responsible for business office activities which include collection of accounts receivable, patient billing, customer service, cashiering, refunds/recoupment's, appeals, and provides refunds for services to patients and third party payers as needed. This position requires that at least three (3) of the functions above are able to be performed.
- High School Diploma/GED is required
- Comprehensive knowledge of healthcare reimbursement.
- Understands medical terminology
- Familiarity with EOB’s and RA’s
- Knowledge of Microsoft Office suite, working knowledge of Excel required.
- Excellent Customer Service
- Good written and verbal communication skills required
- Must be able to multi-task
- Ability to read, write and speak English
- Ability to communicate clearly and concisely with all levels of management
- Bilingual – English/Spanish, preferred
- Previous healthcare experience (2-3 yrs.) required, hospital experience preferred.
- Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties
- Establishes and maintains long-term customer relationships, building rapport with other department staff
- Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.
- Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
- Medical Terminology, ICD-9, ICD – 10, Codes, CPT Codes, HCPCS code, Modifier knowledge required.
- Ability to use the internet to obtain information from Third Party Payers or other sources is required.
- Requires working with minimal to moderate interruptions
- Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
- Receives incoming and outgoing calls from patients and informs them of their balance due after insurance has paid.
- Assists patients and carriers with questions and concerns regarding the billing and collections of accounts.
- Obtains copies of required insurance identification cards, as needed.
- Works special projects as assigned.
- Assist with posting payments and identifying correct I-plan
- Daily download and review report of patient balance for statement release.
- Update address on return mail as needed
- Review RAs and EOB’s total charges, amount of insurance payment and balance owed by patient or responsible party.
- Explains hospital payment policies and collects patient balance due and writes receipts for all payments collected.
- Performs daily reconciliation of petty cash.
- Download and post electronic remits and apply payments and adjustments as per I-plan.
- Make deposits to the bank.
- Researches credit balances for accurate processing of refunds due to over payments and/or allowances requiring a correction in a timely manner.
- Prepares credit worksheet and processes all transactions required to request refund checks or to correct account balances.
- Transfers patient credit balances to outstanding accounts according to hospital policy and procedure, and prepares letters of explanation concerning refund issued to third party payers and patients.
- Researches and prepares quarterly Medicare credit report.
- Responds to all mail and phone calls concerning credit balances and refunds checks.
- Completes provider applications for payers
- Follows-up accounts on assigned ATB and/or custom reports and contacts insurance carrier for payment and/or recoupment’s.
- Enter appropriate mnemonic in the notes tab
- Utilizes tickler, when requesting additional information from other co-workers or departments
- Responds to correspondence from insurance carriers in a timely manner.
- Determines financial status and refers patient for financial screening as appropriate
- Ability to identify accounts that need insurance billing or rebilling
- Adheres to collection tips booklet when contacting insurance carrier.
- Demonstrates proficiency in billing and follow up of Medicare, Medicaid claims on-line or through billing software
- Proficient in accessing information needed from Cerner and AX document imaging software.
- Request copies of medical records from HIM for any paper records
- Ability to access medical records from Cerner system to appeal claims with carriers.
- Enter and maintain appealed accounts through the variable data system.
- Maintain PMMC software system for carrier over and under payments to facility.
- Create appeal letters with appropriate details of appeal
- Select correct adjustment codes on adjustment form to appropriately document reason for adjustment
- Complete adjustment form appropriately with the correct dollar amount assigned to the adjustment code
- Ensures patient confidentiality requirements are met in accordance with HIPAA policies and procedures.
- Other duties as assigned.
LINES OF REPSONSIBILITES:
CFO …. Director …. Manager ….. Supervisor