Under the supervision of the designated supervisor, this position exists to facilitate patient flow from point of entry to destination in a timely, accurate, courteous and professional manner. The incumbent will obtain specific information to generate an accurate financial and demographic record for our patients that will ensure maximum reimbursement and clinical outcomes. This position schedules appointments, interviews patients for appropriate medical information, explains charges and policies of the department and the organization, validates and enters charges into appropriate computer systems, and collects necessary payment. Answers incoming telephone calls and directs patients and visitors appropriately.
Greets and ascertains customer's needs. Responds in an accurate, timely and complete manner to questions or directional needs. Assists with control of public traffic in restricted areas to ensure safety and comfort of all external customers. Escorts customers to appropriate area as needed. Accurately completes registrations and pre-registrations for patients by entering demographic, financial, employment, referring physician and emergency contact information into computer system. Prints appropriate forms to facilitate patient's entire encounter. May request medical records and other related test results prior to patient appointments. Obtains consent and signatures according to specified requirements. Gives attention to the care and comfort of patients and their families. Provides training to new employees utilizing the organization and Departmental policy and procedures. Answers and directs incoming telephone calls and accommodates requests timely according to department processes. Answers questions and provides information to caller within area of responsibility. May enter information from encounter that includes diagnosis, office visits and/or procedures that occurred during patients encounter for generation of patient bill.
Obtains a copy of insurance information and validates eligibility and referral needs if applicable. When applicable reviews all visits for pre-certification, certification, and re-certification. Reviews medical records to obtain clinical information required for authorization. May collaborate with physician or provider as appropriate should additional clinical information be needed to complete prior approval. If authorization denial is received, notifies appropriate staff to work with insurance company and physician's office. May obtain retrospective authorization on visit when pre-certification was not obtained at or before time of visit.
Charge Entry & Payment Posting:
Reviews charge forms for completeness, including CPT, diagnosis, service codes and signatures. Enters the organization charges into computer, processes professional charges according to departmental policy. Verifies that charges were received on all patients seen, performs daily auditing of charges assuring that charges crossed through all computer systems. Follows outlined departmental procedures for posting charges/payments to patient accounts. May perform necessary follow-up procedures to ensure a timely collection process. Contacts physician or provider when additional information is needed to assure accurate bill is sent.
Receives payment of co-pays and prior balances specified by each department. Totals daily cash intake, balances cash drawer, make deposits and follow cash procedures as outlined by department. Ensures ledgers are balanced daily.
Patient Information & Medical Records:
May discern appropriate release of information. Provides and explains information as required by regulatory agencies of federal (HIPAA) and state laws. Complete necessary documentation. Provides and explains insurance information, i.e., referrals, co-pays, charges. Request patient identify which level of information can be announced/disclosed. Processes and distributes requests of informational data for internal and external customers, i.e. disability claims. May make arrangements for records to be copied and mailed to insurance companies upon request if necessary for pre-certification/authorizations. May prepare documents and may process in optical imaging system. Communicates with insurance companies, governmental agencies and physicians to obtain and provide required information. Purge charts/documents in compliance with HIPAA from supervisors directions.
Receives initial phone call from referring physician and/or patient. Directs patients needs and schedules appointments for patients appropriately. Additional ancillary scheduling maybe necessary prior to patients appointments, tries to accommodate patient, physician/provider and ancillary site with coordination of appointment times. Reschedules patient appointments according to departmental schedules and guidelines. May schedule referral appointments for patients with other medical facilities. May generate physician schedule templates. May maintain, edit and fill appointment slots for area(s). May send reminders, pre-registers, pre-calls to patients. Forwards new patient information prior to scheduled appointment.
Participates in required audits including productivity. Follows up on all the organization assigned reports which may include time audits, registration, and productivity.
Inventory and Care of Environment:
Assists in management of department inventory. Maintains clean and orderly work area.
Actively participates in process improvement. Recommends operational policy and/or procedure review and changes when appropriate. Accurately documents issues for management follow up when appropriate.
Ensures compliance with all applicable quality and accreditation standards within the assigned areas.
Assesses patient for special needs/assistance and accommodates accordingly. Escorts patients or arranges transportation as needed. Provides patients with educations materials, written and/or verbal excluding clinical information. Exceeds expectation of patients, family and visitors. Work as a team to assure patient encounter is priority and at best interest.
Maintains at all times the confidentiality of any patient or employee medical, financial, or personal information, and other information, records and data to which there is access. Views, uses or discloses such information only for reasons necessary to perform duties. Responsible to challenge unauthorized individuals from viewing such confidential patient or employee information or accessing restricted areas.
Accountable to demonstrate and foster the organization Service Excellence Service Commitments. Meets expectations of preeminent service, including behavior that models Service Excellence--Every Encounter, Every Time, No Exceptions, No Excuses. Consistently demonstrates the four Service Commitments of the organization (Communication, Quality, Professionalism, and Environment).
The preceding essential function statements are not intended to be an exhaustive list of tasks and functions for this position. Job descriptions provide a representative summary of the major duties and responsibilities performed by incumbents. Other tasks and functions may be assigned as needed to fulfill the mission of the organization.
Job Family: ( Administrative/Clerical/Office )
Job Family || Job Behavior
Requires ability to use a personal computer; knowledge of various software; and skilled data entry skills.
Requires practiced typing ability.
Requires ability to learn and retain medical coding.
ICD-9; CPT coding experience preferred.
Prefer medical/insurance experience.
Requires ability to handle multiple tasks and prioritize work.
Requires ability to work independently; handle detail and work well under pressure.
Requires ability to interpret insurance information; knowledge of clinical practices and medical terminology preferred.
Requires ability to learn regulatory requirements.
Requires ability to effectively interact with a widely diverse population of patients; visitors and staff.
Requires excellent verbal and written communication skills.
Requires excellent interpersonal and customer service skills.
Requires ability to make decisions; problem solve; and to provide sound judgment.
Bloomington Hospital is dedicated to serving the entire community. We recognize that some of our patients may need assistance when...