Medical Office Support Specialist

Location

101 WELLNESS WAY - Nemours Building

Full Time 80 Hours

Days

19.66 - 29.49 HOURLY

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.

• Insurance Authorization for Services/Treatment
  • 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.
  • Proactively ensures insurance authorization is obtained prior to rendering services or treatment; or recommends postponement of services if requirements are not met.
  • Reviews insurance coverage information with patient and coordinates or obtains Advanced Beneficiary Notice (ABN) from patient as applicable.
  • Screen patients for financial assistance programs and initiates applications for various programs as applicable.
  • Works with clinical staff to assure appropriate charge capture and authorizations are received when services/treatments are altered or modified.
• Coding
  • 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.
  • Works actively with clinicians and clinical staff in problem resolution for issues related to diagnosis coding, medical necessity, and regulatory compliance.
• Charge Capture/Billing
  • Accurately posts all technical and professional charges daily in appropriate hospital information system prior to export.
  • 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.
  • Collaborates with supervisor/manager and BMG management team to resolve account issues as requested within billing cycle and in appropriate hospital information system.
• Denial Management
  • Regularly reviews and appropriately follows up on accounts in denial or appeal status.
  • Researches denied claims and incorrect payments. Processes appeals in a timely manner.
  • Ensures all denials and appeals are tracked appropriately and feedback is shared with team members and providers.
• Co-pays and Collections
  • Identifies copayments and attempts to collect and post payments.
  • Notifies patients of outstanding balances and attempts to collect the estimated patient financial responsibility for scheduled appointments.
  • Collaborates with supervisor/manager and Finance Department in the Payment Recovery Program.
  • Responsible for the daily balancing of cash drawers; timely processing of patient credit refunds.
• Registration Oversight
  • Mentors and assists with the orientation and education of employees.
  • Assists Front Desk Assistants in resolving more complicated and complex functions.
  • Assists in onboarding of new Front Desk Assistants; under the guidance of the supervisor/manager.
• Provide cross-support for Front Office Assistants as requested
  • Patient flow – maintains an efficient patient flow during patient arrival processes. Accurately complete reception duties in accordance with policies and patient experience standards.
  • Registration – Precisely identifies all patients, using the national patient identifiers, and accurately completes…