To provide financial counseling to patients and work closely with reimbursement staff and the business office to ensure timely account follow-up.
Essential Duties and Responsibilities
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Other duties may be assigned.
Identifies uninsured and underinsured patients prior to the onset of treatment
Verifies coverage details for potentially underinsured patients, identifying atypical gaps in coverage
Estimates patients financial obligations to the institution
Educates patients regarding insurance coverage and out-of-pocket expenses owed to the institution; addresses patient questions and concerns regarding cost of care; notifies physician if patient chooses not to proceed with treatment for financial reasons
Protects the financial standing of the MFA by determining appropriate payment plans and arranging payment on deposits due
Review order request prior to authorization to ensure conformity with insurance requirements; notifies physician if authorization is denied.
Counsels patients who cannot pay according to the payment schedule, determining appropriate internal and external patient assistance programs to contact for additional support
Serve as an important link in the communication chain; ensuring authorization and financial information is transmitted between nursing personnel, physicians, social worker, and patients; participate in multidisciplinary meetings to address financial needs of patient
Processes charity and patient assistance program applications for all patients who require assistance
Tracks patient assistance program applications to determine outcomes and works with the patient to file subsequent applications if necessary
Submits applications to drug companies for drug replacement; communicates and tracks drug replacement shipments with the assistance of the Practice Manager and Clinical Nurse Manager
Reviews patient accounts regularly to determine if patients with outstanding accounts may require assistance with financial planning or access to financial assistance programs; follows up as necessary.
Works closely with the business office to ensure claims are being filed appropriately, specifically with regards to patient assistance programs
Contributes to department goals by making 100% financial arrangements for each patient prior to the onset of treatment when possible
Adheres to the MFA corporate compliance plan, and to all applicable rules and regulations outlined by accrediting bodies and local, state, and federal agencies
Establishes, with executive approval, internal administrative procedures and controls as related to financial counseling and payment plans.
Updates Electronic Health Record and Practice Management System with authorization and payment information, including updating registration and insurance information for patients.
Display exemplary phone etiquette and focuses on 100% customer satisfaction.
Demonstrate an awareness and sensitivity towards patient/family rights
Cross-trained to provide back-up in other administrative areas within the department, including reimbursement staff and Patient Registration (Check In/Out).
Facilitates patient collections
Supports efficient department operations
Completes special projects for the Department of Surgery
Assumes other duties and responsibilities that are appropriate to the position and area
Understands and supports the MFA's values and guiding principles.
Responds to patients in a friendly, prompt, and caring manner maintaining confidentiality and respect.
Demonstrates positive behavior toward patients, physicians, and coworkers.
Promotes mutual respect and professionalism.
Attention to detail in daily work duties and functions.
Ability to problem-solve using creativity and analytical skills.
Excellent verbal and written communication.
Complies with departmental standards regarding training, professional development, communication, management of workload, and safety/emergency situations.
Ability to perform job duties at satisfactory levels using Allscripts and all other office programs.
The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Associates or Bachelors degree in accounting, business administration or related field, or an equivalent combination of training and experience, is necessary. Certified Coder (CPC or CCS-P) preferred, but will consider if preparing to take the accreditation exam within 12 months. A high school diploma or equivalent; two or more years of college training is preferred.
Two years of prior billing experience for physician practice required. Similar experience with a Surgery Medical Group practice highly desirable. Must have knowledge of insurance industry, medical terminology, reimbursement and pre-certificate. Knowledge of Medicare-Part B (CMS) policy on billing, reimbursement and other third party reimbursement is required. Demonstrated working knowledge of federal and state regulations, insurance policies and procedures.
General supervision received weekly from the Practice Manager & Administrative Manager