Job: Clinic Financial Specialist

This posting has expired and is no longer available.

Jobing Description



Location:Support Services
Zip Code:98310
ID:1663
Department:HHP Cardiovascular, 72641
Shift:Days
FTE:1.0
Shift Hours:Monday - Friday
Job Type:Full-time
On-Call Required:No
Rotating Weekends:No
Rotating Holidays:No

Description

JOB SUMMARY:

The Clinic Financial Specialist is responsible for coding and charge entry, electronic and paper claim submission, and posting of payments from insurance carriers and patients. This includes follow-up of insurance claims, customer service and collections.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

ESSENTIAL DUTIES:

  • Posts all live payments from patients and insurance carriers. Posts insurance payments deposited and batched by Patient Financial Services. Takes care to post payments to correct patient accounts. Makes adjustments to patient accounts according to contractual arrangements.
  • Balances and processes check deposits through IDD.
  • Processes credit card payments via Transaction Express.
  • Balances and prepares cash deposits for pickup by Security.
  • Appeals incorrect insurance payments.
  • Responds to insurance company inquiries regarding claim questions and additional information requests.
  • Researches overpayments and processes refund requests to send to Finance.
  • Demonstrates the ability to assist patients and insurance companies with billing problems.
  • Responds to patients' questions about their accounts in a timely manner.
  • Understands and correctly applies HHP and Harrison's policies for patient financial assistance, prompt pay and other discounts.
  • Investigates and solves 'Problem Accounts'.
  • Checks claims for accuracy to billing and coding regulations.
  • Processes secondary claims electronically or by printing CMS1500 form, attaching EOB, and mailing to payer.
  • Understands the importance of having obtained prior authorizations and referrals for services as required by various insurance plans.
  • Is able to correctly assess the need for case management and how to apply it to a ticket.
  • Utilizes insurance websites to check eligibility, referrals and authorizations, claims status, claims corrections, and appeals.
  • Researches and corrects claims that are pending payment and older than 45 days.
  • Checks file rejections for assigned clinics. Corrects, or instructs registration staff to correct, any registration issues (no SOF, insurance group #, ect) and rebills.
  • Manually moves balances to patient responsibility after electronic ERA's are posted and patient has no other insurance.
  • Pulls prior day charges for assigned clinics. Conducts a quick audit of visit tab confirming correct insurance, place of service, orders, ect. If warranted, reviews medical chart verifying all orders and charges are entered.
  • Has knowledge of the correct ticket set-up for charges. Understands the orders process between the EMR and CPS.
  • Codes hospital services and diagnoses and posts charges to patient's accounts.
  • Reviews sources (ie: schedule, doctors checklists, signed documents list, SIS, STAR reports, Gateway, etc) to ensure complete charge capture. Maintains procedure logs as required. (ie: Surgery Logs)
  • Checks for EMR flags. Answers and researches any questions from providers, medical assistants or other coworkers. Monitors flags sent to providers with inquiries related to billing, coding, or documentation.
  • Treats patients with respect. Maintains confidentiality.
  • Scans and indexes insurance correspondence and other documents as appropriate.
  • Stays current with CPT, ICD-9, HCPCS and modifier changes and correct usage.
  • Has knowledge of and is compliant with government regulations including 'signature on file' requirements, compliance program, HIPAA, etc.

EDUCATION REQUIRED:

High School or equivalent

EXPERIENCE REQUIRED:

minimum 3 years experience in claims, insurance, follow-up, healthcare setting

LICENSE/CERTIFICATION/REGISTRATIONS REQUIRED:

CPC preferred

COMPETENCY:

To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Customer Service:

Recognizes the vital role of customer service by creating a positive impression by acknowledging the customer's presence immediately and with an attitude the patient is the primary focus; Manages difficult or emotional customer situations; Responds promptly to customer needs; Meets commitments; Delivers consistent and value-added services to customers; Acknowledges and greets customers in a professional manner; Keeps customers fully informed of any factors affecting a scheduled delivery; Resolves customer problems at early stages; Utilizes hospital AIDET principles.

Attendance & Punctuality:

Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time; Exhibits regular, reliable, predictable attendance.

Team Work:

Is a strong contributor to a team's success; Encourages the full participation of all team members and supports everyone's efforts to succeed; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Recognizes accomplishments of other team members; Resolves team conflicts with finesse.

Interpersonal Skills & Professionalism:

Focuses on solving conflict, not blaming; Treats other with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Maintains confidentiality; Keeps motions under control; Remains open to others' ideas and tries new things; Acts with positive intent.

Dependability:

Follows instructions, responds to management direction; Meets responsibilities promptly; Is always fully prepared; Is very dependable in accomplishing results during the absence of superiors; Is always reliable in successfully completing all assignments; Displays rigid self-discipline.

Safety and Security:

Promotes safety as a core value of the organization; Observes safety and security procedures; Reports potentially unsafe conditions; Use equipment and materials properly.

Knowledge/Skills:

Extensive knowledge of medical insurance, CPT and ICD-9 codes.

Ability to type 45 words per minute.

Attention to detail and commitment to accuracy

LANGUAGE/COMMUNICATION ABILITY:

Ability to read, write and speak the English language. Ability to communicate effectively verbally and in writing;

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

MATH ABILITY:

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY:

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations

COMPUTER SKILLS:

To perform this job successfully, an individual should have knowledge of Microsoft Word, Excel, and Outlook; Ability to operate standard office machines, such as copier, Fax, desktop computer, etc.; Experience with Centricity Practice Management software preferred.

PHYSICAL DEMANDS:

The employee must regularly lift and /or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.

ADDITIONAL RESPONSIBILITIES:

  • Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
  • Adheres to and exhibits our service standards:
    • Care about me - We put the patient at the center of every decision we make and tailor the hospital experience to the patient's needs.
    • Keep me safe - We adhere to strict safety procedures, and seek new knowledge and experience in pursuit of continuous improvement.
    • Help me heal - We address our patients' physical, spiritual, and emotional needs with the most advanced medicine available and a warm, caring environment.
  • Maintains confidentiality and protects sensitive data at all times.
  • Adheres to organizational and department specific safety standards and guidelines.
  • Works collaboratively and supports efforts of team members.
  • Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.

About Harrison Medical Center:

For more information about what it's like to be part of the Harrison team and live in the Kitsap area, please visit http://jobs.harrisonmedical.org/.

Harrison Medical Center is an Equal Opportunity Employer



Additional Responsibilities:

  • Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
  • Adheres to and exhibits our service standards:
    • Care about me - We put the patient at the center of every decision we make and tailor the hospital experience to the patient's needs.
    • Keep me safe - We adhere to strict safety procedures, and seek new knowledge and experience in pursuit of continuous improvement.
    • Help me heal - We address our patients' physical, spiritual, and emotional needs with the most advanced medicine available and a warm, caring environment.
  • Maintains confidentiality and protects sensitive data at all times.
  • Adheres to organizational and department specific safety standards and guidelines.
  • Works collaboratively and supports efforts of team members.
  • Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.

About Harrison Medical Center:

For more information about what it's like to be part of the Harrison team and live in the Kitsap area, please visit http://jobs.harrisonmedical.org/.

Harrison Medical Center is an Equal Opportunity Employer