Position Status:

Shift:

Hours per week:

Job Information
Exemption Status: Non-Exempt

A Brief Overview
Under direction, responsible for the processing of patient accounts from the point of scheduling to the completion of pre-bill editing. This responsibility includes: Schedule patients for non-complex services, collect and verify the comprehensive data set, identifying managed care issues and referring as appropriate for resolution; complete required forms including Medicare MSP, if required; verification of insurance eligibility and benefits via electronic transactions, websites or phone calls; insurance pre-certification, liability calculations, financial education and finalization of financial resolution with patients; financial assistance screening; complete additional registration admission, discharge and transfer functions as applicable; resolve edit failures following established policies and procedures. These activities are completed following established policies and procedures, and in compliance with Joint Commission, Medicare, Payer contracts, HIPAA, regulatory agencies and the organization's Code of Conduct.

Education Qualifications

• High School Diploma / GED Required
• Associate's Degree Preferred

Experience Qualifications

• 2 years Experience in a clinical healthcare setting such as physician's office or hospital relating to patient financial services, patient registration, patient scheduling or related healthcare experience. Required

Skills and Abilities

• Working knowledge of basic medical terminology. Intermediate understanding of medical/clinical treatment processes. (Required proficiency)
• Detailed knowledge of major third-party billing and contract requirements. (Required proficiency)
• Keyboarding skill or typing skill of at least 30 wpm. (Preferred proficiency)
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or government regulations. Superior written and oral communication skills. Ability to effectively present information and respond to questions from management, physicians, employees and the general public. (Required proficiency)
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages. Ability to apply concepts of basic Algebra. (Required proficiency)
• Ability to work independently with strong analytical and problem solving skills utilized to determine work prioritization, coordination, application of departmental procedures and resolve complex customer service issues. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Ability to define problems, collect data, establish facts, and draw valid conclusions. (Required proficiency)

What you will do

• Ensures customer concerns are processed in compliance with organization's policies while maintaining the highest level of patient and employee rights, including confidentiality of patient information and personnel issues.
• Ensures necessary data, identified processing issues and related information is provided to departmental management, appropriate departments and individuals within the organization in a timely manner.
• Identifies and notifies management of customer service issues and potential process/system problems that cause billing and payment errors and assists in improvement implementation as requested. Informs management of any known or suspected violations by other employees or suppliers.
• Accurately schedule office visits based upon the physician preferences and needs of the patient. At time of scheduling, determine the type of financial education and required forms for that patient. (Medicare ABN, or Financial Obligation.) Reschedule and cancel patient appointments as requested by the patient or physician. Accurately selects the correct patient when scheduling services to avoid duplicate medical record numbers and treatment and billing errors.
• Identify insurance sources, collect and document detailed and accurate insurance information in a timely manner. Consistently and accurately documents accounts with activities as needed in a timely manner. Collect and update the comprehensive data set at the time of scheduling, validate patient information and determine in or out of network insurance status.
• Correctly applies a detailed understanding of all technical primary and secondary billing rules and policies and procedures for assigned third party payors and contracts.
• Assists with the revision or development of the department's internal documents, procedural manuals and forms, as requested.
• Answers questions from other staff or clinic offices by phone or e-mail in a timely manner.
• Welcome all customers to the facility in a friendly manner, offering assistance by giving directions or escorting patients to service areas. Consistently uses diplomacy and respect both in person and when using the telephone, and performs effectively and professionally under stressful conditions.
• Attends and participates at departmental team meetings, work-groups and other organizational educational programs. Attends internal and external seminars for personal growth and development and shares pertinent information with other team members. Completes the annual mandatory in-services and other conditions of employment requirements. Reads and comprehends correspondence from government and third-party payors to keep abreast of new regulations, policies and billing and payment requirements.
• Remind patients to bring required information, referral forms, co-pays and deductibles, etc. at the time of service. Instruct patients where and when to arrive, including directions on how to reach the facility from out of town and where to park.
• Determine estimate of charges when appropriate and calculate patient liability for scheduled service. Negotiate financial resolution through proper sequencing of resolution options and patient’s ability/willingness to pay. Initiate referral for financial assistance screening (Hospital Assistance Program or Patient Financial Advocate) when applicable. Determine and explain financial impact to patient of the Medicare ABN, Blue Cross Financial Obligation, Financial Obligation and others.
• Complete electronic insurance verification for all participating payers using an electronic eligibility system. Complete manual/telephone insurance verification as needed based upon established criteria.
• Identify and complete Medicaid and charity screening, when applicable.
• Review schedules and accurately prioritize order of processing based on established criteria. Collect and update the comprehensive data set and validate patient information with patient prior to arrival for service for those not completed at the time of scheduling.
• Apply advanced technical billing knowledge to track and resolve pre-service/service data edits. Clear all applicable comprehensive data bill edits in system.

Required for All Jobs

• Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health
• Performs other duties as assigned

Patient Facing Options

• Position is Not Patient Facing

Remote Work Guidelines

• Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards.
• Stable access to electricity and a minimum of 25mb upload and internet speed.
• Dedicate full attention to the job duties and communication with others during working hours.
• Adhere to break and attendance schedules agreed upon with supervisor.
• Abide by Stormont Vail’s Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.

Remote Work Capability

• Hybrid

Scope

• No Supervisory Responsibility
• 
  
• No Budget Responsibility No Budget Responsibility

Physical Demands

• Balancing: Occasionally 1-3 Hours
• Carrying: Occasionally 1-3 Hours
• Climbing (Stairs): Rarely less than 1 hour
• Driving (Automatic): Rarely less than 1 hour
• Eye/Hand/Foot Coordination: Continuously greater than 5 hours
• Feeling: Occasionally 1-3 Hours
• Grasping (Fine Motor): Frequently 3-5 Hours
• Grasping (Gross Hand): Rarely less than 1 hour
• Handling: Occasionally 1-3 Hours
• Hearing: Frequently 3-5 Hours
• Lifting: Occasionally 1-3 Hours up to 20 lbs
• Pulling: Occasionally 1-3 Hours up to 20 lbs
• Pushing: Occasionally 1-3 Hours up to 20 lbs
• Reaching (Forward): Occasionally 1-3 Hours up to 20 lbs
• Reaching (Overhead): Occasionally 1-3 Hours up to 20 lbs
• Repetitive Motions: Occasionally 1-3 Hours
• Sitting: Frequently 3-5 Hours
• Standing: Frequently 3-5 Hours
• Stooping: Rarely less than 1 hour
• Talking: Frequently 3-5 Hours
• Walking: Frequently 3-5 Hours

Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment.

Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.