Business Office Specialist I, RMF Revenue Cycle

DHR Health - US:TX:Edinburg - Days

Summary:

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

Position Summary:

This position is responsible for business office activities which include collection of accounts receivable, patient billing, customer service, cashiering, refunds/recoupment's, appeals, and provides refunds for services to patients and third party payers as needed. This position requires that at least three (3) of the functions above are able to be performed.

Position Education/Qualifications:

• High School Diploma/GED is required
• Comprehensive knowledge of healthcare reimbursement.
• Understands medical terminology
• Familiarity with EOB's and RA's
• Knowledge of Microsoft Office suite, working knowledge of Excel required.
• Excellent Customer Service
• Good written and verbal communication skills required
• Must be able to multi-task
• Ability to read, write and speak English
• Ability to communicate clearly and concisely with all levels of management
• Bilingual English/Spanish, preferred

Job Knowledge/Experience:

• Previous healthcare experience (2-3 yrs.) required, hospital experience preferred.
• Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties
• Establishes and maintains long-term customer relationships, building rapport with other department staff
• Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.
• Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
• Medical Terminology, ICD-9, ICD 10, Codes, CPT Codes, HCPCS code, Modifier knowledge required.
• Ability to use the internet to obtain information from Third Party Payers or other sources is required.
• Requires working with minimal to moderate interruptions
• Requires reasoning ability and good judgment.
• Ability to handle pressure, meet deadlines, and remain productive in challenging situations.

Responsibilities:

• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
• Receives incoming and outgoing calls from patients and informs them of their balance due after insurance has paid.
• Assists patients and carriers with questions and concerns regarding the billing and collections of accounts.
• Obtains copies of required insurance identification cards, as needed.
• Works special projects as assigned.
• Assist with posting payments and identifying correct I-plan
• Daily download and review report of patient balance for statement release.
• Update address on return mail as needed
• Review RAs and EOB's total charges, amount of insurance payment and balance owed by patient or responsible party.
• Explains hospital payment policies and collects patient balance due and writes receipts for all payments collected.
• Performs daily reconciliation of petty cash.
• Download and post electronic remits and apply payments and adjustments as per I-plan.
• Make deposits to the bank.
• Researches credit balances for accurate processing of refunds due to over payments and/or allowances requiring a correction in a timely manner.
• Prepares credit worksheet and processes all transactions required to request refund checks or to correct account balances.
• Transfers patient credit balances to outstanding accounts according to hospital policy and procedure, and prepares letters of explanation concerning refund issued to third party payers and patients.
• Researches and prepares quarterly Medicare credit report.
• Responds to all mail and phone calls concerning credit balances and refunds checks.
• Completes provider applications for payers
• Follows-up accounts on assigned ATB and/or custom reports and contacts insurance carrier for payment and/or recoupment's.
• Enter appropriate mnemonic in the notes tab
• Utilizes tickler, when requesting additional information from other co-workers or departments
• Responds to correspondence from insurance carriers in a timely manner.
• Determines financial status and refers patient for financial screening as appropriate
• Ability to identify accounts that need insurance billing or rebilling
• Adheres to collection tips booklet when contacting insurance carrier.
• Demonstrates proficiency in billing and follow up of Medicare, Medicaid claims on-line or through billing software
• Proficient in accessing information needed from Cerner and AX document imaging software.
• Request copies of medical records from HIM for any paper records
• Ability to access medical records from Cerner system to appeal claims with carriers.
• Enter and maintain appealed accounts through the variable data system.
• Maintain PMMC software system for carrier over and under payments to facility.
• Create appeal letters with appropriate details of appeal
• Select correct adjustment codes on adjustment form to appropriately document reason for adjustment
• Complete adjustment form appropriately with the correct dollar amount assigned to the adjustment code

Ensures patient confidentiality requirements are met in accordance with HIPAA policies and procedures.

• Other duties as assigned.

Lines of Responsibilities:

(Chain-of-command)

1. Patient Accounting Supervisor 2. Director of Professional Revenue Cycle 3. VP of Revenue Cycle 4. Chief Ambulatory Officer

Customer Service:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.

Age Specific:

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirement relative to his or her age.

Americans with Disabilities Act (ADA):

A. Essential Duties : Indicated by bold print within performance standards, preceding individual numbered criteria.

The following table provides physical requirements that will be associated with, but not limited to, this position:

Light/moderate lifting up to 20 lbs, from the floor to shoulder height. - Yes - Kneeling - Yes

Must be able to assist other employees with lifting more than 20 lbs. - Yes - Walking - Yes

Light/moderate carrying up to 20 lbs. - Yes - Standing/Squatting - Yes

Straight pulling - Yes - Sitting - Yes

Pulling hand over hand - Yes - Pushing - Yes

Repeated bending - Yes - Stooping/Bending - Yes

Reaching above shoulder - Yes - Climbing Stairs - Yes

Simple grasping - Yes - Climbing Ladders - No

Dual simultaneous grasping - Yes - Depth Perceptions needed - Yes

Ability to see - Yes - Identify Colors - Yes

Operating office equipment - Yes - Twisting - Yes

Operating mechanical equipment - Yes - Crawling - No

Ability to read and write - Yes - Ability to Count - Yes

Ability to hear verbal communication without aid - Yes - Operating Personal Vehicle - Yes

Ability to comprehend written/verbal communication - Yes - Other: Ability to deal with stress - Yes

OSHA Category - III

B. Working Conditions : The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature