Medical Office Support Specialist

Bayhealth Medical Center offers a competitive salary and comprehensive benefits package (for eligible positions) including:

• Generous Paid Time Off and Paid Holidays
• Matching 401(k)/403(b) Plans
• Excellent Health, Dental, and Vision
• Disability and Life Insurance options
• On Site Child Care
• Educational Reimbursement
• Health Care and Dependent Care Flex Spending Accounts
• Plus, an array of Voluntary Benefits to include Critical Care Coverage and more!

Location: Heart and Vascular Institute

Status: Full Time 80 Hours

Shift: Days

Salary Range: $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. The Specialist 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, and provides oversight, training, cross-coverage and maintains proficiency in the duties of scheduling and front‑office functions, including registrations needed for efficient day‑to‑day operations of the facility.

The Specialist 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: 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 ensures insurance authorization is obtained prior to rendering services or treatment or recommends postponement 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.
• 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.
• Charge Capture/Billing: a) Accurately posts all technical and professional charges daily in appropriate hospital information system prior to export. b) Verifies charge entries within 24 hours of posting using defined audit processes and available reports, and regularly resolves charge work queue issues. c) Collaborates with appropriate clinical staff and managers to resolve outstanding issues and performs additional charge audits as requested.
  
  d) Collaborates with supervisor/manager and BMG management team to resolve account issues as requested within billing cycle in appropriate hospital information system.
• Denial Management: a) Regularly reviews and appropriately follows up on accounts in denial or appeal status. b) Researches denied claims and incorrect payments. c) Processes appeals in a timely manner and ensures all denials and appeals are tracked appropriately and feedback is shared with team members and providers.
• 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) Collaborates with supervisor/manager and Finance Department in the Payment Recovery Program. d) Responsible for daily balancing of cash drawers and timely processing of patient credit refunds.
• Registration Oversight: a) Mentors and assists with the orientation and education of employees.…