Working in the role of Business Office Support you will coordinate and clarify patient-specific financial and business aspects of care for all patients under the Center.  Collects accurate patient demographic and billing information in a timely manner, and maintains records of same.  Advises patients of service costs and alternative sources of funding.  Coordinates registration and schedule processed for all aspects of the Center.  Verifies insurance of all patients and works with health insurance providers to determine coverage and benefit limits as applicable to treatment provided by the Center.  Participates in business office functions including organization and tracking of patients within the center, creating new and innovative modes of payment for developing services, and contributing to the business development of the center.   Submits requests for and obtains procedure authorizations and pre-certifications from health insurance providers as needed for all patients of the center.  Re-submits appeals related to denials.  Works with other members of the Center’s interdisciplinary team, insurers and administrative personnel at Memorial Medical Center.  Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values.

Education:

• Bachelor’s Degree in Business, Communication, or a related field required.  Completion of two (2) years of college coursework coupled with two (2) years of financial, billing/insurance or related experience may be considered in lieu of degree.

Experience:

• Minimum 1 year of customer service experience required.
• Experience with Microsoft Office products such as Microsoft Word and Excel required.
• Medical terminology, medical office, registration or billing experience required.
• 1-3 years previous experience as a Financial Coordinator or similar position with a related health care payer or clinical office preferred.

Other Knowledge/Skills/Abilities:

• Demonstrates excellent interpersonal and communication skills to ensure positive relationships with all customers.
• Must be highly organized and efficient in work processes.
• Must be able to plan, coordinate and control all responsibilities inherent to position.
• Must be professional, self-motivated and command excellent written and oral communication skills.
• Multi-task oriented, and ability to work independently.

1. Obtains detailed patient insurance benefit information for all patients in the Center as they relate to treatments provided at the Center.

2. Presents benefits, other financial information and general program overview to patients and/or family in person, as well as over the phone.

3. Advises patients on insurance and billing issues and options, including self-pay or bank loan options. Serve as a resource for patients and family members on financial matters.

4. Submits requests for authorization along with supporting documents to insurance payers. Verify coverage and other medical benefits and acquire necessary referrals and authorizations.

5. Embodies the Memorial Health System Performance Excellence Standards of Safety, Courtesy, Quality, and Efficiency that support our mission, vision and values:

• • SAFETY: Prevent Harm - I put safety first in everything I do.  I take action to ensure the safety of others.

• • COURTESY: Serve Others - I treat others with dignity and respect.  I project a professional image and positive attitude.

• • QUALITY: Improve Outcomes - I continually advance my knowledge, skills and performance.  I work with others to achieve superior results.

• • EFFICIENCY: Reduce Waste - I use time and resources wisely.  I prevent defects and delays.

6. Monitors and update record information regarding insurance data, referring physicians, payer authorizations, and preferred providers. Assist patients with questions concerning insurance and other financial issues.

7. Coordinates and communicate with MMC managed care representatives to compare insurance benefits with MMC’s wound- specific contracts in order to secure approval for services.

8. Participates in interdisciplinary treatment team conferences and communicate relevant financial information to team members.

9. Works with MMC Patient Access Services and MMC Patient Financial Services to coordinate patient registration and billing processes.

10. Performs special projects, analyses, and audits as directed by director, administrator or physician(s). This may include, but not limited to, participation in non-clinical support duties for clinical operations such as patient tracking, organizing patient lists, or facilitating non-clinical required patient activities.

11. Assists Patient Financial Services to resolve patient billing issues.

12. Routinely review procedure charge and procedure billing summary reports to ensure accurate patient billing. Communicates errors to PFS in a timely manner.

13. Participates in department’s performance improvement activities.

14. Coordinates all registration and scheduling functions for the Center.

15. Complies with all reimbursement rules and regulations, including Corporate Compliance Plan. Complies with established department policies and procedures and safety standards.  Accountable for achieving quality standards.

16. Responsible for several tasks related to patient tracking and daily office/clinic operations. This aspect may include, but is not limited to; working with incoming mail, faxes and e-mails; proper release of medical records; timely dissemination of physician referrals and medical records to program staff and the affiliated satellite sites; initiating correspondence; updating electronically medical records are entered and/or uploaded; Applies the Minimum Necessary Standard when accessing protected health information.  Monitors employees to ensure they do the same.

17. Performs other related work as required or requested.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job.  Incumbents may be requested to perform tasks other than those specifically presented in this description.