Business office clerk job description

PATH (People Acting to Help) Inc. is a comprehensive Community Behavioral Health and Intellectual Disability Center. We offer a wide of array of services and supports to meet the needs of our community in Northeast Philadelphia. PATH regularly achieves the highest levels of accreditation including a 5 Star Provider Rating by CBH, Philadelphia’s Managed Care Entity, and recognition and awards related to our high-quality, innovative programs and staff accomplishments and contributions.

Our Mission? To Help Individuals Achieve a More Independent and Fulfilling Life.

WHY WORK AT PATH?

PATH understands the importance of having benefits, and so a comprehensive package is offered to our employees including:

A company sponsored 403b retirement plan, Health Insurance (Medical Services, Prescriptions, Dental & Vision), Sick Leave, Personal & Vacation Time, Paid Holidays, Life Insurance, and Long-Term Disability!

JOB SUMMARY:

To promote the mission of PATH to help individuals achieve a more independent and fulfilling life by being an effective team member. Obtain financial information from clients to assess their ability to pay for service, including sliding-scale for Self-Pay clients. Post all charges as related to liability tasks. Review existing clients on a regular basis to ensure on-going coverage. Collect co-pays for Self-Pay, Medicaid Fee-For-Service and Medicare clients. Provide Accounts Receivable staff with information needed for billing Guarantors.

QUALIFICATIONS:

• High School Diploma
• Two years increasingly responsible experience with medical or behavioral healthcare insurance coverage determination of clients.
• General knowledge of insurance terms and practices.
• Knowledge of MA billing and third-party billing.
• Experience dealing with the public in person and by telephone.

SPECIFIC DUTIES:

• Interview new clients to determine coverage, if any, and complete financial application to determine client liability based on the Sliding Fee scale.
• Compute client liability for services based upon the information provided and EVS status.
• Enter client registration information in the computer.
• Add/update client liability and/or funding status in the computer.
• Upon completion of initial eligibility, mail packet of signed forms along with all other documents as determined if the interview is completed by telephone.
• Run EVS for scheduled clients and on a regular basis for all clients.
• Inform supervisor of funding source discrepancies.
• Complete liability waiver form for BH Director to approve and sign, if appropriate.
• Collect co-pays for Sliding Fee clients.
• Collect deductibles and co-pays for clients who have Medicare coverage only.
• Collect deductibles for clients who have Medicaid Fee-For-Service coverage (General Assistance).
• Update client data in computer as it becomes available.
• Perform all other duties as assigned.

PHYSICAL DEMANDS:

Minimal in nature.

Knowledge, Skills & Abilities:

The Business Office Level II employee, under the supervision of the Business Office Manager or Director of Business Operations, is responsible for the financial success of the facility in regards to revenue cycle management. The employee should have a full understanding of each of the processes to maximize reimbursement: registration, insurance verification, coding and billing accurately, posting of payments and processing appeals, and collections on outstanding balances. It is understood that business office clerks will change tasks from time to time to meet the needs of the business.

Projects a professional demeanor and appearance while maintaining the confidentiality of patients, co-workers, and the surgery center and adhering to the HIPAA policy. Reports, in good faith, any known or suspected activity that appears to violate laws, rules, regulations or the SP Code of Conduct. Fulfills annual Healthstream continuing education requirements.

Personal attributes include the ability to be self-directed; demonstrates accountability, professionalism, and receptiveness to change; seeks guidance, direction, and assistance when needed. Works under stress and in situations that demand patience, stamina, endurance, and tact while providing impeccable service. Fosters an attitude of teamwork and willingness to assist others and does not refuse performing other job duties as requested within the hospital or hospital outpatient department. Set's priorities, responds timely to issues, which require a decision, and ensure desired results are achieved by means of consistent, follow through.

Qualifications:

* Demonstrates eligibility for employment in the U.S.
* High School graduate or equivalent
* Minimum of one year of experience in business office activities within a healthcare environment
* Ability to relate and work effectively with others
* Demonstrated verbal and written communications in English for contacting payors, patients, and co-workers
* Demonstrated computers skills in utilizing work processing, integrated database, and understanding of mathematical calculations and medical terminology
* Willingness to participate in goal-setting and educational activities for own growth and advancements
* Ability to use office machines ( copiers, faxes, and scanners), and telephone systems
* Proficiency using and knowledge of Microsoft Office, computers, patient accounting systems and Microsoft Excel

Patient Population:

The patient population served by South Texas Spine & Surgical Hospital is a minimum of 12 years and/or of adult stature to geriatric patients requiring or seeking pain and/or surgical intervention. In addition our hospital outpatient department patient population served by South Texas Spine & Surgical Hospital is a minimum of 6 months to geriatric patients.

Physical Requirements:

May be expected to lift up to 25 pounds or up to 50 pounds with assistance. Work is of light demand; sitting or walking most of the time while on duty. Visual and auditory acuity and manual dexterity essential to performing designated duties required: optimal auditory acuity required; manual dexterity involving the handling of equipment and computers is essential to performing assigned duties. Physical conditions are clean, neat and well-lit. May be subjected to stressful situations. Climate control and ambient temperature variances may be experienced associated with a normal office environment. Hours of duty may be irregular or unexpectedly extended due to the requirements of the Business Office.

OSHA Exposure Classification:

Job Category III. Tasks/activities do not entail predictable or unpredictable exposure to blood or other body fluids to which universal precautions apply.

Duties and Responsibilities

PEOPLE

1. Assigned tasks to be completed accurately, and within specified time lines.

2. Assures Health Stream education is up to date and completed prior to annual evaluation.

3. Participates in regular departmental staff meetings and facility-wide meetings.

4. Always on time for work and attendance is within company policy guidelines

5. Willingness to assist in orientation of new staff and ensuring a high level of employee satisfaction and retention.

6. Performance self-evaluations to be completed and returned before scheduled date for annual performance review.

SERVICE

1. Develops and maintains a culture of service in department, connecting organizational values to actions.

2. Utilizes every opportunity to improve the patient's understanding of financial responsibility.

3. Assures the department provides a high level of Patient Satisfaction through interactions, discussions, and recognition of team members.

4. Assures a high level of Physician Satisfaction with responsible departments, models interactions with physicians to managers and staff, and participates in development and implementation of action plan as needed for improvement.

5. Effectively accesses SP Service area resources and implements recommendations.

QUALITY

1. Assures that business office systems are in place to maintain compliance with State, Federal, and accreditation standards.

2. Complies with departmental policies and procedures to meet regulatory and community standards.

3. Admissions

* Accurate and complete registration of patients
* Explanation of estimated insurance benefits to patients
* Collection of deductible, co-pays, co-ins and other amounts as indicted on estimated insurance benefits worksheet
* Maintain flow of registered patients to pre-op staff
* Answer phone promptly and professionally

4. Coding and Billing are compliant and tasks are performed within SP benchmarks.

* Medical Record is coded accurately within three days of date of service
* Charges are posted and billed accurately, either electronically or paper within one day of final coding. Performs proper review of the medical record and implants logs to assure appropriate charge capture.
* Correspondence is reviewed, and actions taken to resolve issues.
* Verifies the acceptance of electronic claims filings and resolves any issues in a timely manner.
* All available cases are billed by month end close.

5. Payment posting and processing appeals and refunds are performed daily with close attention to detail to eliminate errors.

* Posts all payments accurately and timely within SP benchmarks
* Utilizes contract matrix and reimbursement tools as applicable to ensure accuracy of posting payments
* Knowledgeable of accurate adjustments and contractual write-offs of contracted, non-contracted, Medicare and Worker's Compensation carriers

6. Completes month-end tasks in patient accounting software as required.

FINANCE

1. Manages collection activities to maximize revenue to assure budgeted EBITDA results are achieved.

2. Account management is performed according to SP benchmarks and guidelines

* Actively participates in achieving the monthly collection goals
* Contacts carriers within 25 days to verify claim status and resubmission of claims as necessary
* Contacts patient's as necessary to discuss financial responsibility
* Turns over un-collectable accounts per policy
* Knowledgeable of appeal/denial logs and process correspondence accordingly
* Utilizes adjustment and refund journals in accordance with established guidelines

3. Participates in reducing cost of office supply usage resulting in cost effective operations of areas of responsibility.

4. Prepares weekly, monthly and other necessary reports in accordance with deadlines.

5. Analyzes aging and appeal reports and participates in the development and implementation of action plans as needed.

6. Participates in the fiscal management of the facility to assure effective billing, collection, appeals, and accounts payable management, in accordance with SP benchmarks.

7. Ensures effectiveness of internal controls through following all general accounting principles.

8. Overtime is justified and approved in advance

GROWTH

1. Tracks Managed Care contract compliance with payment terms, authorization requirements and timelines for renegotiation.

2. Manage work process to maintain high quality standards on increasing case volume.

3. Employee stays current with ICD-9, HCPCS coding, and modifier changes as applicable.

4. Utilize all available automation tools. Introduce new or improved tools when applicable.

5. Provide excellent customer service to all internal and external customers