Company: Covenant HealthCare
Posted on: November 8, 2019
FULL TIME BENEFITED
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
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
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.
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
* 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
* 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
* 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
* 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
* 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
* 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
* 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
* Supports the therapy staff with patient care activities as
assigned (Lokomat monitoring, stand-by assist for
* 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
* Maintain alertness for unique situations (potential red
flag/identity theft, patients presenting without a physician
Covenant HealthCare is an equal opportunity employer.
Keywords: Covenant HealthCare, Saginaw , OFFICE SPECIALIST, Administration, Clerical , Saginaw, Michigan
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