Bayhealth Family Medicine

STATUS: Full Time 80 Hours

SHIFT: Days

General Summary:

This is a multi-faceted role within Bayhealth Medical Group (BMG). The Specialist is responsible for obtaining and verifying the accuracy of insurance authorizations and the precise recording of diagnosis codes. Resolves failed medical necessity concerns and billing issues with clinical staff. Identifies patients without adequate insurance coverage and coordinates financial counseling. Performs scheduling for patient testing. Provides oversight, training, cross-coverage and maintains proficiency in the duties of scheduling and front office functions, including registrations necessary for the efficient day-to-day operation of the facility. Screens patients for financial assistance, government, and charitable programs to ensure hospital bill resolution. The Specialist serves as the liaison between customers, insurance carriers and the department while maintaining compliance with applicable regulatory requirements.

Responsibilities:

1. Insurance Authorization for Services/Treatment a) Verifies or obtains referring Clinician authorizations and ensures all diagnosis and procedure codes are accurate and appropriate prior to service delivery; works closely and collaboratively with physician offices. b) Proactively works to ensure insurance authorization is obtained prior to rendering services or treatment; or recommends postponement of services if requirements are not met. c) Reviews insurance coverage information with patient and coordinates or obtains Advanced Beneficiary Notice (ABN) from patient as applicable. d) Screens patients for financial assistance programs and initiates applications for various programs as applicable. e) Works with clinical staff to assure appropriate charge capture and authorizations are received when services/treatments are altered or modified.
2. Coding a) Ensures all diagnosis codes and charges are accurate according to official CPT and ICD-10 CMS guidelines, meeting all applicable State and Federal laws and regulations. b) Works actively with clinicians and clinical staff in problem resolution for issues related to diagnosis coding, medical necessity, and regulatory compliance.
3. Charge Capture/Billing a) Accurately posts all technical and professional charges daily in appropriate hospital information system prior to export (i.e., EMR system, Horizon, etc.) b) Verifies charge entries within 24 hours of posting, using defined audit processes and available reports, and regularly resolves charge work queue issues. Collaborates with appropriate clinical staff and managers to resolve outstanding issues. Performs additional charge audits as requested. c) Collaborates with supervisor/manager and BMG management team to resolve account issues as requested within billing cycle and in appropriate hospital information system.
4. Denial Management a) Regularly review and appropriately follow up on accounts in denial or appeal status. b) Research denied claims and incorrect payments. Processes appeals in a timely manner. c) Ensure all denials and appeals are tracked appropriately and feedback is shared with team members and providers.
5. Co-pays and Collections a) Identifies copayments and attempts to collect and post payments. b) Notifies patients of outstanding balances and attempts to collect the estimated patient financial responsibility for scheduled appointments. c) Collaborate with supervisor/manager and Finance Department in the Payment Recovery Program. d) Responsible for the daily balancing of cash drawers; timely processing of patient credit refunds.
6. Registration Oversight a) Mentors and assists with the orientation and education of employees. b) Assist Front Desk Assistants in resolving more complicated and complex functions c) Assist in onboarding of new Front Desk Assistants; under the guidance of the supervisor/manager
7. Provide cross-support for Front Office Assistants as requested: a) Patient flow – maintains an efficient patient flow during patient arrival processes. Accurately complete reception duties in accordance with policies and patient experience standards. b) Registration – Precisely identifies all patients, using the national patient identifiers, and accurately completes registrations. Interviews patients to confirm data accuracy. c) Documentation – Scans physician orders, related documentation, identification cards, insurance cards for each encounter. d) Insurance Verification- Enters all applicable insurance plans in the correct order, verifies payer eligibility and benefits for each payer, and enters corresponding account notes. e) Scheduling – accurately schedules new patients and follow up appointments, following procedures and protocols. Assist patients with referral needs in obtaining additional appointments with specialists, and insurance approval authorization for additional visits.
8. Surgical Scheduling for Clinicians a) Become proficient in Essential Functions of Surgical Scheduling. b) Meet with patients, schedule pre-op and post-op appointments. c) Schedule cases and equipment with OR/Interventional Lab/Endo Suite; order special equipment from purchasing; notify equipment reps of cases and equipment needed. d) Schedule cases per each Clinician's preference; making sure all authorizations are requested, received and provided to the hospital; schedule add-on cases as needed when providers are on call. e) Provide appropriate procedure and diagnosis codes for surgery schedulers at BHKC or BHSC. f) Maintains a system to ensure that all post-surgery patients are seen in a timely manner.
9. All other duties as assigned within the scope and range of job responsibilities.

Required Education, Credential(s), and Experience:

• Education: High School Diploma or GED
• Credential: None Required
• Experience: Two (2) years of medical office/ insurance clerical experience; prior experience with CPT and ICD-9/ICD-10 coding.

Preferred Education, Credential(s), and Experience:

• Education: Associate Degree Specialized training in accounting principles, medical coding, medical terminology
• Credential: Certified Professional Coder; Certified Billing and Coding Specialist; Certified Healthcare Access Associate; Certified Coding Specialist
Experience: 3 years of medical office/ insurance experience, with administrative billing functions, health information systemsTo view a full list of all open position at Bayhealth, please visit:


https://apply.bayhealth.org/join/