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OFFICE SPECIALIST

Company: Covenant HealthCare
Location: Saginaw
Posted on: November 8, 2019

Job Description:

Description



COVENANT HEALTHCARE

US:MI:SAGINAW

DAY SHIFT

FULL TIME BENEFITED



Summary:
The Therapy Office Specialist is responsible for completing the scheduling, pre-registration and registration processes. This includes obtaining and verifying insurance to determine eligibility and corresponding benefit levels. Based on findings, calculates patient liabilities. Assures the patient understands their financial obligation, identifies payment solutions and collects liabilities.
This position is responsible for staying current on coding, insurance/billing requirements, as well as keeping up to date with government regulations and Covenant HealthCare insurance contracts. Obtains and verifies that the Consent for Treatment/Release of Information and payor specific documents are signed according to legal guidelines and administrative policies. Informs and helps to educate patients on Advance Directives. Observes strict patient confidentiality and adheres to policies and procedures.
The Therapy Office Specialist is responsible for prompt and accurate clerical, registration and billing practices and follow-up for all hospital and related professional service provided to patients covered by third party payers including: Medicare, Medicaid, Blue Cross, Commercial, Workers Compensation and all Managed Care Programs. This position is also responsible for securing accurate documentation and processing for timely and accurate reimbursement from third party payers and patients based on appropriate registration/billing and follow up activities. Supports the therapy staff with patient care activities as assigned.
Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to Extraordinary Care for Every Generation.



Responsibilities:
Contributes to organization success targets for net operating margin through patient satisfaction and quality outcomes.
* Demonstrates excellent customer service. Greets and services patients and family in a courteous, professional manner. Ensures that customer needs are addressed and expectations are met and/or exceeded.
* Resolves patient billing inquiries and problems, follows up on outstanding balances due from insurance companies and patients in collaboration with CBO.
* Able to assist patient/family with questions or concerns about their account as it pertains to payment/reimbursement and works with CBO in setting up payment contracts.
* Has a thorough knowledge of all HMO, PPO, and managed care contractual relationships and is able to determine if correct treatments and procedures were provided.
* Reviews charges for accuracy of diagnostic/procedure codes and determines the codes necessary to properly reflect services provided.
* Provides technical support to therapists by identifying inconsistencies in documentation, diagnosis and/or prescriptions and ensures accuracy for proper reimbursement.
* Has a thorough knowledge of scheduling and staffing and makes independent decision in order to maximize revenue opportunities.
* Works with CBO and HIM to ensure proper measures are in place for payment (electronic or hard copy, including initial billing, all insurance re-billing, and secondary or subsequent billings).
* Maintains knowledge of federal, state and local billing regulations. Informs management and compliance department of discrepancies.
* Analyzes and strictly adheres to all rules/regulations and quickly responds to changes when notified by insurance carriers, employers, third party payers, or government agencies.
* Responsible for efficiently, accurately and appropriately maintaining legal medical records for all patients.
* Responsible for education of staff regarding billing accuracy requirements for clean claims, prior authorization, referrals, certifications/re-certifications, CPT/ICD coding, etc.
* Obtains and verifies patient insurance and demographic information and enters necessary updates to system for billing purposes.
* Determines, processes, and receive self-pay payments and accurately reconciles daily cash intake.
* Facilitates and investigates referral and authorization status for managed care patients.
* Ability to handle varying levels of stressful situations under pressure of deadline with frequent interruptions, while remaining professional, responsive and cooperative.
* Maintains multiple computer on-line sign-ons and has ability to interpret and glean necessary information from multiple insurance resources/websites.
* Understands the Revenue Cycle.
* Processes release of information requests consistent with HIPAA and HIM requirements.
* Answers and responds to multiple phone lines providing appropriate information and/or directs calls to appropriate staff.
* Able to prioritize workload effectively. Attention to detail and exceptional organizational skills required.
* Properly maintains legal medical record through accurate point of service scanning and maintenance of paper and electronic records.
* Supports the therapy staff with patient care activities as assigned (Lokomat monitoring, stand-by assist for transfers/ambulation, etc.).
* Accurately records interview information necessary for work flow of other departments (Clinical Resource Management, Central Business Office, Nursing Units, Security, Pastoral Care, Physician Offices, MMR, etc.)
* Has extensive knowledge of the various billing regulations for multiple insurances to correctly determine set up, coverage assignment and filing order of insurances.
* Fiscally responsible to request/accept/post payments of cash, check/echeck, credit cards and/or set up payroll deduction. Explains and supplies patient with accurate receipt.
* Demonstrates expertise/proficiency in use of multiple computer programs including: EPIC; ADT; Cadence; Enterprise Billing; Microsoft Office; Passport; Real Time Eligibility; Patient Payment Estimator; and Address Verification.
* Able to correctly identify and assign guarantors for all patient types including auto, third party liability, patients who are minors, custodial parent, etc.
* Works independently, proactively analyzes situations, identifies alternative solutions to make appropriate decisions.
* Acts as gatekeeper in following process identifying private patient (non-publish) policy.
* To enable electronic claim submission without CBO intervention is responsible for utilizing insurance verification tools to accurately verify patients insurance information. Identifies co-insurances, co-pays, deductibles, non-covered/self pays and provides patient with estimation of their liability.
* Responsible to tactfully and respectfully communicate patient financial obligations and point of service collections processes. Familiar with Discounting Financial Assistance policies.
* Able to complete a registration including understanding the differences in workflows/protocols when registering the following type patients: CMU, PICC Line, tooth extraction, city/state employee, patient in network vs out of network, workers compensation, occupational medicine, motor vehicle accident, JP Farley insurance, out of state Medicaid, patient accompanied by Child Protective Service staff, foreign address, foreign insurance, employed through employment agency, St. Mary s Health Insurance, ABW County Health Plan, Michigan Lutheran Seminary, Michigan Department of Corrections, Saginaw County Jail Inmates, Research Studies, VA Medical Center and when a patient needs HAR created for documentation purposes.
* Maintain alertness for unique situations (potential red flag/identity theft, patients presenting without a physician order).

Covenant HealthCare is an equal opportunity employer.

Keywords: Covenant HealthCare, Saginaw , OFFICE SPECIALIST, Administration, Clerical , Saginaw, Michigan

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