Business Office Specialist - HCA (Tallahassee, Florida) in Tallahassee, Florida For Sale

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. SUPERVISOR: Business Office Manager SUPERVISES: None CLASSIFICATION: Non-Exempt DUTIES INCLUDE BUT ARE NOT LIMITED TO: Registration: 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. Billing: 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. Collections: 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. Scheduling: 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. BEHAVIORAL SPECIFIC EXPECTATIONS: Adheres to all company policies and procedures. Adheres to HCA Code of Conduct and HIPAA requirements. Adheres to personnel policies and programs which specify privileges and responsibilities of employment, including compliance with an adverse incident reporting system, quality improvement program, patient safety initiatives, and risk management program. Displays willingness to speak up about safety issues or change practices to enhance safety Asks questions when needs
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