Healthcare Administration And Health Care Science Degree - Revenue

Job Description: Positions: Level 1: Certified Ophthalmic Coding Specialist Level 2: Senior Certified Ophthalmic Billing Specialist Department: Patient Accounts Reports To: Practice Administrator Job Summary: Level 1: This individual is responsible for checking patients out, scheduling follow-up appointments, updating recalls, real time insurance verification, ensuring that there has been proper coding on all claims prior to billing, preparing all insurance claims, verifying medical necessity has been met for: testing procedures and office/outpatient surgeries; obtaining prior authorizations for surgeries, and collecting/balancing all forms of patient payments. Level 2: (In addition to level 1 responsibilities) This individual is responsible for filing all insurance claims (paper and electronic claims transmission), reviewing and following-up on all incorrect payment amounts or denials; posting all incoming insurance payments both manual entries and EFT payments, verify insurance has paid correctly according to assigned fee schedule, balancing the business office daily business activities, closing out each day’s receipts for the deposit; complete all patient/insurance follow-up and collections on past due accounts; make necessary write-offs and refunds according to the financial policy, and responsible for sending statements and collections. Education/Experience and Requirements: · Bachelors Degree in Health Administration, Health Science, or related field. · Previous healthcare work experience 2 to 5 years. · Computer Background with practice management software. · General knowledge of physician business office procedures. · General knowledge in the operation of a computer. · General knowledge of Microsoft Excel, Word, and Outlook. · Obtain OCS- Ophthalmic Coding Specialist certification within one year of employment. · Complete monthly compliance training as required by OSHA and HIPAA. · Take Practice Management classes assigned by supervisor based on job responsibilities. · Complete CE as required to stay current on changes in the medical industry and for certification. · Take Corcoran classes assigned by supervisor based on job responsibilities. · Employee must exhibit understanding and how to apply what was taught to them. Essential Skills and Abilities - Ability to exercise a degree of initiative and judgment.Ability to establish and maintain effective working relationships with patients, management, medical staff, co-workers, and the public.Physical abilities: sit for extended periods of time; push, pull, and reach; occasionally bend, stoop, and stretch.Hand eye coordination and manual dexterity needed to operate keyboard, photocopier, telephone, and other office equipment.Must be adaptable to change, highly motivated, and possess a positive attitude.Ability to act independently and exercise good judgment.Possesses excellent communication skills through grammar, telephone and writing communication with doctors, Practice Administrator, staff members, business contacts and the public through.Demonstrate the ability to work with geriatric patients and patients of all ages.Determines appropriate customer service actions and follows through in a timely and decisive manner with the ability to evaluate situations and provide suggestions of resolution.Responds appropriately in stressful situations.A degree of creativity and latitude is expected. Demonstrates flexibility, works with minimal direct supervision.Demonstrates the ability to direct others in accomplishing work.Demonstrates professional, administrative, supervisory and/or specialized knowledge required to perform the job.Creates a culture supportive staff, which fosters individual motivation, high levels of individual and team performance, and quality of skillsRepresents self and situations honestly.Responds appropriately to criticism and to suggestions for work improvement.Delegates authority when appropriate.Is well organized, prioritizes tasks and uses time productively; plans and organizes work, coordinates with others, establishes appropriate priorities.Completes tasks in a timely fashion or as designated by timeline. Personal Skills: This individual must be a professional, possess a positive attitude, be a team player, highly motivated, adaptable to change, create efficient work patterns through organization, pay special attention to detail, demonstrate strong customer service/ communication skills with patients, doctors, managers and co-workers, computer literate, multi-task oriented and possess values and beliefs that are in accordance with the practice’s core values. Level 1: Responsibilities Location: Insurance and Charge EntryObtain real time insurance information for deductibles, out of pockets, copayments, and co-insurance for patients.Verify collection balance has been paid, or is current if on payment plan.Collect copayments, deductibles, previous balances, co-insurance, refraction fees, contact lens fitting fees, glasses, accessories, and contact lens balances according to the financial policy.Inform patients of Administrative Fee, if current fees and any additional fees due at time of service are not paid when services are rendered.Obtain Prior Authorizations for in-office procedures, outpatient surgeries, and medically necessary contact lens.Daily charge entry and claim setup for all examinations, office procedures, surgeries, and miscellaneous appointment types, and submission of paper claims via fax to Social Security Determination according to office protocol.Ensure all claims are properly coded and are ready for the claims process.Electronic claims transmission for all vision services;Submit all VSP claims via interface according to protocol.Submit all EyeMed claims online.Reconcile all payments and charges, transact/balance; credit card, check, online, and cash transactions, and run End of Day Reports according to financial policy.Pre-appoint patients for follow up appointments, surgeries, annual exams, and office procedures.Process Care Credit applications, transactions, and payments.Revalidate every 2years. (Consisting of watching video, answering questions, printing off the certificate and filing it in the Care Credit folderPractice Management System-Add new employers, occupations, cities to tables.Table maintenance (If Provider information changes.)Obtain NPI information, including direct email for new physician’s entries in office database.Overview of the clinic, diagnostic testing, and the optical department to understand the responsibilities of each department and how they contribute to the success of the practice.Add/Insert New Insurances to system for electronic or paper billing according to protocol.·Responsible for communicating with supervisor when updates are needed for credit card terminals. BillingUnderstand the key components of the Medicare/Medicaid programs as it relates to OphthalmologyUnderstand the key components of our most common commercial carriers as it relates to OphthalmologyMaintain and understand the key components of the Medicare Advantage Plans as they relate to OphthalmologyComplete Billing Department Monthly AnalysisMaintain an efficient claims processing and follow up processMaintain an efficient and profitable billing, coding and collection process as directed by our financial policyMaintain Medical Coding ManualOversee billing department policies and procedures for efficiency and to maximize reimbursement-Set-up and maintain direct deposit accounts for insurance companies and MECA.Maintain release of patient protocol and coordinate policies and procedures with Practice Administrator in order to make necessary write-offs and refunds – small balance, thresholdIdentify low payer, slow payers and delinquent payers(billing specialists to report to supervisor)Maintain computer edit issues for the patient accts/services deptEnter new CPT codes into the practice management systemFollow fee calculation protocolImplement all correspondence as it relates to Ophthalmology for: - billing specialists too – educate staff and doctorsMedicare list serves and bulletinsMedicaid bulletinsVSP global newsUpdate and maintain Botox payment allowance on a quarterly basis and make appropriate adjustments to the fee schedule and practice management system. Inform staff of updates on fees.Update and maintain taxonomy codes.Maintain banking protocol to prevent theft – as discussed and defined by accountant and administratorAddress and correct any serious edit or denial issues we have with clearing houses when processing claims or staffing issues.Handle all claim audits from insurance companies and discuss with administrator and delegate to Patient Services Department.Maintain Payor ID ProtocolInsurance spread sheetMaintain protocol for deleting duplicate accounts and deleting transaction errors for billing department, front desk, and optical. Responsible for front desk and optical transactions – Anne to teach Matt and billing specialists.Maintain forms and protocol for the use of office waivers:ABNDMEMedicarePatient Liability WaiverMedicaidFinancial Hardship WaiverMaintain practice management billing protocol according to database instructionsAssess the need for practice management system updates from Compulink every six monthsMaintaining diagnostics for the practice management systemMaintain and organize billing department databaseMaintain and organize billing department interface forms on practice management systemMaintain and inform staff of the patient financial programs we offer.Payment online and via phone Coding / Reimbursement: Understand when to bill a New Patient (NP) office exam or Established Patient (EP).Understand when to use 92 vs. 99 codes on insurance claims on Medicare, Medicaid, and Commercial Policies (Anthem).Apply modifiers when appropriate.Understand insurance payment/coding guidelines.Coding and billing of all surgical services.Coding and billing of all hospital consultations.Coding and billing of all office services such as examinations, procedures, lasers, diagnostic tests, and optical.Verify the necessity for pre-certifications for surgeries, office procedures and diagnostic tests.Maintain standards for documentation by staff and doctors for insurance carriers.Proficiently use CPT, ICD-10, and HCPCS electronic reference books.Maintain and proficiently understand the LCDs for the Medicare contractor and other insurance policies.Maintain the Medical Coding Manual and CCI edit manual.Know how to reference the “How to Manual” in the Patient Accounts Folder.Utilize the fee schedules to ensure the correct deductible amount is collected.Understand medical and vision plans in order to maximize reimbursement.Understand when a waiver is needed for insurance benefit limitations (Patient Liability Waiver, Advanced Beneficiary Notice, and Medicaid waiver).Understand the key components and payment guidelines of the Medicare/Medicaid and Commercial programs as it relates to Ophthalmology and Optometry in order to maximize reimbursement. Refund Adjustments: · Process returns/exchange of merchandise for optical and contact lenses. · Process all patient refunds. · Process all insurance refunds. · Process all replacement refund checks that either the patient or insurance has not processed. · Follow up on Unclaimed Property/Checks as directed by the Accountant. · Assist Optical Department Manager with material voids as directed. Level 2: Responsibilities Location: Patient Accounts Department Collections: · Work small balance write offs at the time insurance payments are posted according to protocol. · Process NSF checks. · Review inefficiencies in the office (example: Copays not being collected at time of appointment). · Run patient statements once a week. · Work Patient Responsibility Report and segregate based on collection process - Statements. - Past due statements. - Final notice. - Threshold Balance and indicate reason for balance. - Collections Balance and indicate reason for balance. - Responsible for setting up payment plans as outlined in the protocol. · Run Collections Accounts Report weekly according to protocol. · Apply collection recovery payments from Komyatte Law office. · Monitor No show appointments, and add fees according to financial policy. Payment Processing/Posting: · Identify low payer, slow payers, incorrect payers, and delinquent payers to Practice Administrator and Business Office Manager as they occur. · Utilize the fee schedules to determine the correct payment was made by the insurance. · Auto post ERAs/EFTs insurance payments. · Process insurance check payments. · Apply contractual adjustments as appropriate. · Transmit insurance claims daily. · Identify and correct any denied or rejected claims while running claims processing daily. · Address Business Office Manager with any denied payment disputes. · Audit visit coding to ensure that highest level codes. Insurance/Claim Follow Up: · Run the Insurance Receivable by Carrier Report to work unpaid claims, check for claims stuck in the system, and claims on hold. · Utilize and understand the Office Weekly Accounts-Receivable Analysis worksheet. · Update VSP and Eyemed of any Professional Fee changes as it applies. · Review VSP and Eyemed charges every December. Insurance Contracting: · Obtain and update fee schedules when they become available for all insurances · Communicating new insurance networks/plans, and new insurance updates to the Practice Administrator and staff when notification is received. · Credential and link new providers to our practices group insurance contracts. Company Description: Munster Eye Care Associates, P.C. has been in business for over 30 years. We are a small business located in Munster Indiana that provides general ophthalmology and general optometric services. It is the intention of Munster Eye Care Associates, P.C. to deliver the highest quality and personalized surgical, medical and vision care.