We have the great privilege of helping patients and families re-build their lives. It's extraordinarily meaningful work and the reason we greet the day with optimism and anticipation. When patients "Ask for Mary," they experience a culture that has been sculpted for more than a century. Our hallmark is to carefully listen to patients and innovatively serve them. This is true of every employee, from support staff and leadership, to clinicians and care providers.
Mary Free Bed is a not-for-profit, nationally accredited rehabilitation hospital serving thousands of children and adults each year through inpatient, outpatient, sub-acute rehabilitation, orthotics and prosthetics and home and community programs. With the most comprehensive rehabilitation services in Michigan and an exclusive focus on rehabilitation, Mary Free Bed physicians, nurses and therapists help our patients achieve outstanding clinical outcomes.The growing Mary Free Bed Network provides patients throughout the state with access to our unique standard of care.
Restoring hope and freedom through rehabilitation.
Diversity, Equity and Inclusion:
Mary Free Bed values diversity and inclusion among patients, families and staff. We strive to hire people who reflect the communities we serve. Our employees will serve all patients, families and each other with dignity and respect.
This position is in an outpatient office setting. Duties include all clinic scheduling, receiving and posting payments to patient accounts, coding services appropriately based on information provided by the therapist on the patient encounter form, verifying the insurance benefits of the patient, explaining and answering all patient's questions regarding coverage and co-insurance/deductible responsibilities supporting the treatment philosophy of the outpatient service, collecting data for quality measures, data entry of quality measures, and assist in the management of the program's flow of patients. Accurately collects information from multiple sources to process referrals for outpatient services, and verification of benefits for outpatient services. Analyzes and records the required demographic, insurance, and clinical data sets, other information, and signatures necessary to schedule and pre-register outpatient patients and ensure that bills are produced according to regulatory and payer requirements. Effectively completes medical necessity and managed care requirement screening, and determines insurance type and eligibility to ensure maximum payer compliance is maintained and maximum reimbursement is secured. Verifies and/or authorizes insurance as assigned.
Interacts in a customer focused manner during referral processing to ensure that the patient's and their representative's needs are met, and that they understand their personal liabilities through various payment and program options. Demonstrates complete understanding and knowledge of all processes and procedures related to insurance verification, coordination of benefit, insurance prior authorization, and registration. Performs all insurance verification and communicates appropriate verbal and written explanations to patients, family members, and/or other appropriate parties. Assists in prevention of retroactive denials. Works cooperatively with other departments and outpatient staff/leadership to assure financial reimbursement for outpatient therapy services.
Essential Job Responsibilities:
Answer all incoming calls for outpatient and route appropriately.
Schedule initial evaluation and subsequent patient appointments following scheduling protocols.
Create patient account and cases in the practice management system following system protocols.
Obtain benefit information from carriers for all new courses of treatment.
Obtain authorization for treatment as required by the patient's carrier prior to their first appointment and subsequent appointments as needed.
Call all new patients the day before their initial evaluation to remind them of their appointment time and paperwork to bring to their appointment.
Daily printing of encounter forms and schedules.
Review new patient information forms with patient at their first appointment. Ensure all forms are completed, signed and dated following protocols.
Administer and collect functional outcome measures at baseline, and periodically for the duration of the patient's course of treatment.
Obtain copies of the patient's insurance card(s).
Enter charges on a daily basis in the practice management system following system protocols.
Scan incoming paperwork in the patient charts.
Initiate customer service and process improvement projects, or as assigned
Other duties as assigned by Leader.
Assists in full process quality control by reviewing and analyzing data to maintain a level of compliance to produce an accurate timely claim avoiding patient responsibility therefore reducing accounts receivable days.
Analyzes the available documentation and uses software and/or other listings or information, including the data gathered during the third party eligibility and benefit verification, in order to calculate the amounts expected to be received from the payer and the amount owed by the patient or his/her responsible party
Research patient benefits with health insurance carriers to determine coverage and benefit limitations for all referrals received.
Reviews appropriateness of ICD10 and CPT codes to determine if care provided corresponds to reason for referral/authorization to ensure that patient's insurance covers the evaluations/treatments.
Accurately generates patient specific Explanation of Benefit Forms and distributes to patients/representatives and appropriate internal parties on a timely basis.
Adhering to benefit and authorization monitoring process to accurately relay benefit information to all involved parties. Alerts appropriate parties for any ongoing monitoring or authorization needs.
Provides information and explanations to the patient or responsible party regarding the policy and various options for resolving the patient's financial responsibility for non-covered services prior to the service being provided. Initiates and explains the Advance Beneficiary Notification process as necessary.
Provides pre-appointment telephone explanations/letters to patients and other appropriate parties. Ensures that the patient or representative understands the policies that govern the revenue cycle and provide various options for resolving the calculated patient financial responsibility for non-covered services.
Provides un-insured/under insured patients by screening for appropriate community resources that may be available to them in order to secure coverage for services, such as Community Financial Aid, Processing Presumptive Medicaid Eligibility, directing families to apply for Children's Special Health Care Services and/or Medicaid, etc.
Provides the patient or responsible party with financial counseling to achieve a mutually acceptable resolution of the expected self-pay balance including such options as credit card payments, deposits, extended/external payment arrangements and screens for and initiates charity care. Refers the patient or responsible party to other internal or external sources as applicable
Accurately prepares, produces, and distributes to other internal and external parties as appropriate and on a timely basis, forms, schedules, and supportive clinical documentation.
Handles appointment cancellation requests from patients in the event insurance coverage is not available and forwards to schedulers to reschedule appointments as appropriate. Completes the sending of the return-to-doctor communication in the event the patient decides not to receive services
Enters calculated expected patient co-pay and co-insurance amounts in Cerner. Sets follow-up dates in Share Point to monitor out-of-pocket maximums to determine amounts met. Updates Cerner and Share Point notes accordingly
Upon notification of health plan change or updates, including monthly Medicaid changes, resulting in a re-verification to determine coverage.
Completes new-hire therapist orientation to review Outpatient Benefit Specialist/Financial Coordinator policies and procedures to guide in finding patient benefits. Respond to requests for additional information.
Collects, Compiles, analyzes, and reports data requested by manager.
Provides clerical support as requested
Accurately collects and analyzes all required demographic, insurance, guarantor and clinical data elements necessary to process/pre-register outpatient therapy referrals and schedule all types of patients; records and electronically enters the information on a timely basis.
Reviews physician referrals/orders and other documentation according to internal policy and regulation as applicable, in order to assure that the service being provided has been appropriately documented and meets all known payer medical necessity and other criteria. Initiates contact to physicians and other office staff to resolve questions and problems. Initiates and explains the Advance Beneficiary Notification process as necessary. Alerts appropriate parties for any ongoing monitoring or authorization needs.
Reviews notes and other documentation according to internal policy and regulation as applicable, in order to ensure that a treatment prescription and authorization has been received to support scheduling of ongoing therapy appointments.
Receives and properly responds to telephone, electronic, or face-to-face inquiries from patients or their representatives.
Completes timely posting of cash collections, accepting and generating appropriate receipts for monies and credit card payments received.
Essential Job Qualifications (Knowledge, Education, and Training Requirements):
Associates Degree or equivalent work experience
Proficient with e-mail and computer use. Will be expected to easily learn and use Mary Free Bed scheduling software
Must have excellent attention to detail
Must be able to multi-task efficiently without loss in accuracy or focus and follow-through
Independent in problem-solving
Must be able to type 40 words per minute with 98% accuracy, ten-key and operate general business office equipment
Demonstrate excellent customer service
Demonstrate organizational and problem solving skills
Must have information management skills to communicate, explain, interpret and present data
Must be able to quickly learn and retain a large amount of specific protocols and processes. Must also be able to retain changes in these protocols as they occur and hold other accountable to them.
Able to exert up to 10 pounds of force occasionally (up to 1/3 of the time)
Able to lift, carry, push, pull, up to 10 pounds occasionally
Able to sit for the majority of the time, but may involve brief periods of time involving walking or standing.
Able to use keyboard frequently (1/3 to 2/3 of the time)
Other Preferred Job Qualifications:
Solid working knowledge of ICD-10-CM and CPT coding structures.
Completion of medical office coursework.
Knowledge of medical terminology.
Previous experience in similar position or tenure at practice to accept this position.
Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, genetic information, veteran status, disability or other legally protected characteristic.