POSITION SUMMARY

GENERAL EDUCATION REQUIREMENTS

ADDITIONAL QUALIFICATIONS

• Proficient in all coding systems to include ICD-10, CPT-4, and Healthcare Common Procedure Coding System (HCPCS).
• Typing requirement of 40 words per minute.
• Knowledge of Medical Terminology.
• Knowledge of medical billing and coding practices in multiple specialties including Dental.
• Knowledge of SMS Signature in order to troubleshoot Business Office operational problems.
• Proficiency in using Electronic Medical Record or Electronic Health Record software, billing system.
• Attention to accuracy and specific detail for competent performance.
• Effective organizational skills to complete responsibilities in a timely manner.
• Technical competency in the area of health care computer applications.
• Strong verbal and written communication skills.
• Ability to read and write at high school level.

PRIMARY ACCOUNTABILITIES

• Determine insurance eligibility and accurately enter insurance information into Practice Management System (PMS); assists Patient Service Representatives in determining insurance coverage and with documentation in PMS.
• Perform all posting functions from insurance companies and private payments for both medical and dental claims on a weekly basis.
• Effectively communicate with various insurance companies regarding claim denials and issues related to insurance eligibility. Documents information in PMS via Financial Notes for traceability regarding claim status during posting process.
• Create daily Pre-Edit reports and communicate effectively with appropriate personnel regarding the claim process.
• Determine reasons for payment denials from insurance companies and submit corrected claims and/or appeals.
• Assist Patient Service Representatives and Patient Registration Counselors with correcting charge entry errors and determining insurance eligibility.
• Responsible for all reporting as required by assigned insurance companies.
• Communicate effectively with patients their financial responsibility; assist patients via phone with patient payments and coordinating payment posting with respective clinics.
• Perform all functions regarding the process of batching and sending insurance claims electronically. Review and correct claims that error out during the batching process.
• Answer telephones properly, courteously, and tactfully dealing with the public, physicians, and outside businesses.
• Routes patients to the appropriate clinic when calling to schedule appointments.
• Effectively deals with complaints and/or billing questions.
• Assist with area clerical duties such as typing, photocopying, filing, scanning, and faxing documents, medical records, reports, and other materials.
• Document calls, if necessary, in patient file. Respond to phone messages in a timely manner.
• Prints, sorts, and organizes paperwork, reports and/or materials to be sent out. Prepares outgoing correspondence to include folding, stuffing, and postage stamping. Mails/sends out or distributes paperwork, reports and/or materials.
• Verify address, phone number and insurance information are current in the Practice Management System when patients call regarding billing issues.
• Performs other duties as requested by Business Office Supervisor and Business Office Manager.
• Takes ownership and represents Brevard Health Alliance’s mission and organizational goals established by the executive committee. These include, but are not limited to: Productivity, Quality, Patient Satisfaction, and Employee Retention. It is the duty of each BHA employee to incorporate these goals into all daily work routines and strive to achieve and surpass all goals by working as a team. The mission and goals of BHA will be incorporated into each associate’s Key Performance Indicators and will be evaluated on a monthly and quarterly basis.

PHYSICAL DEMANDS

• Visual acuity, hand-eye coordination, hearing ability and dexterity to perform tasks and operate office equipment.
• Standing, walking, bending, stooping, and lifting as job requires for possibly extensive periods of time.
• Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment.
• Normal range of hearing and eyesight to record, prepare and communicate appropriate reports.

MENTAL DEMANDS

• Work in a stressful, public contact environment.
• Professionalism, courtesy, and respect required when interacting with patients and staff.
• Concentration on multiple priority activities in a fast paced, stressful environment.
• Exercising of appropriate judgment when responding to emergency or complex situations.
• Maintenance of confidentiality in accordance with Health Insurance Portability and Accountability Act (HIPAA).
• Assess and interpret data to educate staff.