The Revenue Cycle Specialist position encompasses all aspects of the Front Desk Representative, Insurance Verification Clerk and Medical Records Clerk, in addition to data entry of certain Clinical Data.
Key Responsibilities:
Front Desk Representative - Responsible for all aspects of the front desk duties, including patient check-in, answering multi-phone lines and preparation of patient charts. - Greets patients and their care persons arriving for appointments pleasantly and graciously, asking them to please sign in.
- Completes registration accurately. Assures signatures are complete as necessary in the medical records, e.g., on the consent, insurance forms and release of information form.
- Assist patient with admission packet.
- Copies insurance cards as required.
- Collects, deductibles, fees and co-insurance payments before procedure is done. Enters information on financial log.
- Directs patients and their family to the waiting area and provides routine information in accordance with the policies of the Center.
- Informs appropriate personnel of patients arrival and status.
- Reviews upcoming surgery schedules on a daily basis and obtains all necessary information prior to date of surgery.
- Assembles patient chart according to procedure being performed and affixes appropriate label.
- Verifies that all patient charts are completed prior to day of surgery.
- Answers all incoming telephone and intercom calls courteously and in a professional manner.
- Handles/forwards all calls according to Centers policy.
- Accepts and relays messages in an effective manner.
- Notifies appropriate personnel of patient cancellations.
- Communicates with physicians office concerning admissions and activities relative to patient care.
- Monitors the patient waiting area for cleanliness and reassures family members and guests as necessary.
- Is responsible for turning off coffee, copier, lights, etc., and locking the doors.
RESPONSIBILITY Insurance Verification Clerk - Responsible for verifying all patients insurance information prior to surgery and determining any copays and/or deductibles. - Initiates contact with patients insurance company and verifies coverage and amount of copay/deductible as applicable.
- Enters all benefits information in the VISION software system.
- Obtains authorization for services as required per patients insurance terms.
- Prepares Patient Estimate of Charges based on benefits verified.
- Notifies patient of any copay and/or deductible due prior to surgery.
- Sends Patient Welcome Packet to include Patient Estimate and Surgery Information.
- Informs Clinical Manager and Surgery Scheduler of any cases that have not received authorization for the next business day.
RESPONSIBILITY Medical Records Clerk - The Medical Records Clerk is responsible for the medical record component of the ambulatory surgery facility to include monitoring and organization. - Locates all Medical Records for the next days surgical cases and forwards them to the Front Desk.
- Maintains files by ensuring that they are organized and in pre-determined order.
- Plans and develops medical record system to attain the facilitys goals and meets standards of accrediting and regulatory agencies.
- Responsible for all correspondence received (physician, patient, attorney, etc.) to include form letters and records requests.
- Sends daily schedule to transcription company
- Develops, analyzes and technically evaluates medical records.
- Identifies problem areas and assists in their resolution.
- Initiates correspondence regarding suspensions and delinquent records once approved by the Business Office Director, Chief Administrative Officer and Medical Director.
RESPONSIBILITY Clinical Data Entry Entry of supplies, implants and clinical times in the VISION software system. - Enter all supplies used in a surgical case in the appropriate area of the VISION software system.
- Enter all surgical times in the VISION software system
- Enter information for all Implants used in a surgical case in the VISION software system.
EQUIPMENT USED TO PERFORM ESSENTIAL JOB FUNCTIONS:
Basic Office Equipment:
- Copy Machine
- Fax Machine
- Telephone
- Mail Machine
- Calculator
- Computer/Keyboard
- Printer
Qualifications
Education: A high school diploma is required. Effective oral and written communication skills in English are required.
Experience: One to three years previous experience in insurance accounts is required. Prefer previous experience processing facility fees. Ability to practice tact, diplomacy and confidentiality.
Job Skills and Requirements:
- Must be computer literate with at least six (6) months experience in computerized accounting systems.
- Must have knowledge of and ability to perform basic office tasks.
- Must be skilled in medical terminology with a comprehensive knowledge of surgical procedures.
- Must have comprehensive knowledge of reimbursement procedures and contractual guidelines.
- Must be skilled in patient population age based competencies to include attention spans, comprehension and cognitive skills, hearing, sight and mobility limitations/alterations.
- Must be familiar with insurance policies and how to read patient benefits.
- Must be organized and able to multi-task.