JOB SUMMARY
Responsible for verification and data entry of patient demographics, insurance eligibility, and benefit verification. Calculates, communicates, and collects patient financial responsibility before, during, or after services are provided, as appropriate. Negotiates, processes, and follows up on payment plan agreements. Files insurance claims and works rejected or errored claims. Assists the CMP clinics as appropriate. This is an entry level physician billing position.
Job Specific
1. Verify patient demographics and proper completion of all required patient registration forms, including accurate data entry into practice management system. (EF)
2. Verify medical insurance eligibility and benefit coverage, including accurate data entry into the practice management system. (EF)
3. Determine or calculate patient financial responsibility using all available tools (e.g., insurance patient estimators, internal calculation spreadsheets, insurance fee schedules, etc.). (EF)
4. Screen clinic schedules for high balances and bad debt utilizing all available tools (e.g., Phreesia, practice management system, etc.) and attempt to collect prior to the scheduled appointment. (EF)
5. Collect, process, post, and deposit patient payments, including working the prepay bucket in the practice management system. (EF)
6. Set-up and process payment plan agreements and financial assistance applications, including delinquent payment follow-up. (EF)
7. File professional claims daily. Reviews and corrects any claim rejections and edits, or forwards to the appropriate team member for correction, and resubmits rejected claims after correction. (EF)
8. Review, print, and/or process patient statements in accordance with established timelines. (EF)
9. Organize, process, and complete the deposit protocol daily, including data entry into the general ledger. (EF)
10. Sort, transport, and deliver mail and interdepartmental mail throughout the hospital campus. (EF)
11. Document all patient, insurance, or other communication in accordance with departmental policy. (EF)
Teamwork & Communication
12 . Assist the CMP clinics with check-in and check-out functions. (EF)
13. Assist the CMP clinics with patient demographics, insurance eligibility, insurance benefit verification, and data entry. (EF)
14. Provide excellent and professional customer service, at all times, to patients, staff, managers, and clinicians.
15. Consult team members, supervisor, director, and other appropriate resources to resolve billing and collection questions and issues. (EF)
16. Maintain a collaborative working relationship with clinic staff, managers, clinicians, and the coding department.
17. Plan and participate in departmental meetings with clinic staff, managers, administrators, advanced practices providers, and physicians. (EF)
Education
18. Once obtained, maintain professional certifications as required by the certifying organization. (EF)
19. Remain current with most recent revisions of billing and collections standards and federal regulations to comply with all legal requirements regarding billing and collection practices. (EF)
20. Actively participate in all required in-service education.
Hospital:
-
Adheres to organization-wide and other applicable policies and procedures.
-
Day-to-day performance complies with the hospital’s Service Excellence Behavioral Expectations.
-
Performs within the prescribed limits of the hospital’s Ethics, Compliance and Confidentiality Program guidelines.
-
Performs within professional Scope of Practice at all times.
Other Duties As Assigned:
-
Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
