Billing Spec I
Responsible for the complete and accurate capture of patient insurance data and referral / authorization management. Includes tracking and creation of referrals for all visits. Contacts patients by telephone to collect missing pertinent data. Communicates with referring physicians and/or practices to obtain prior approvals for services. Reviews and responds to denied claims and works toward denial recovery. In addition, he/she will perform other related duties as required.
- JOB RELATIONSHIPS
Reporting directly to the Business Operations Manager, in addition, will work collaboratively with the Medical Specialties Staff and the CPN Coding Division, Practice Financial Analysts to ensure accurate charge entry information. Position works closely with the Physicians of all medical specialty divisions. The incumbent will participate as a highly collaborative member of the CPN administrative and management team.
- AUTHORITY and ACCESS TO SERVICES
Has the authority to acquire, verify and organize patient data for reimbursement purposes.
Has the authority to represent hospital (SEMC) and professional (CPN) policies and processes to staff and department members.
- PRIMARY RESPONSIBILITIES & ESSENTIAL FUNCTIONS
1.) "Provides superior customer service to internal and external clients, customers,
and patients as referenced in the Service Excellence Standards."
2.) Practices and promotes a "patient-centered care model" within administrative standards.
3.) Provides primary fiscal management of all patient insurance and insurance referral data. The principle focus is to ensure that all pending services have appropriate insurance coverage and is reimbursable. If a patient has no insurance coverage a free care application and approval must be on file at CSEMC prior to rendering services. It is the expectation that all pending services will be cleared for reimbursement 5 business days prior to the appointment date (unless it was added to the appointment schedule within that time frame).
4.) It is expected that all telephone communication will be answered or initiated in a cheerful and welcoming manner as per the policy of CSEMC.
5.) Review and respond to all insurance rejection and/or claim denial reports for CSEMC and professional billing agencies. Initial review will be made in collaboration with the Manager and/or Practice Coordinator. However, the Billing / Referral Coordinator is responsible for follow through of the recommendations made and achieving denial recovery of those charges. All responsive documentation is to be retained and filed for continual monitoring and follow up.
6.) Coordination of all office supplies and documents.
7.) Perform all other related or similar duties as required or as requested by the attending-in-charge or the Managing Director.
8.) Participates in role expansion, personal and center development.
B. Responsibilities/Non-Essential Functions: Assist with administrative cross-coverage and other assigned duties.
- REPORTING REQUIREMENTS
Reports to the Business Operations Manager of the Multi-specialty Clinic.
Shall be accountable for maintaining the confidentiality of all CPN and patient related information. Shall abide by all CPN policies and procedures.
- MINIMUM QUALIFICATIONS and EXPERIENCE: Associates Degree, 2-3 years experience in Referral/Billing Management
- MINIMUM SKILLS/ABILITIES : Computer literacy, Familiarity with Referral/Insurance Eligibility Programs, Microsoft Office including Word, Excel, Access