Business Office Specialist - FT -Days - RMF Revenue Cycle Details

Business Office Specialist - FT -Days - RMF Revenue Cycle

DHR Health - Edinburg, TX

Employment Type : Full-Time

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

• 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.