Responsible for all business office functions including admitting activities for patients, financial counseling, claims follow-up and collections, data analysis, charge entry and eligibility determination.
KEY RESPONSIBILITIES:
- Works effectively with the A&R staff to maximize all pre-admission activities.
- Oversees and ensures accuracy of all Pre-admission functions as they relate to the Business Office. Responsibilities include, but are not limited to, pre-admission verification of demographic and insurance information for patients being referred to facility for treatment and data entry of all pertinent information into the data processing system.
- Responsible for ensuring that the outpatient and inpatient daily and monthly statistics are balanced daily and reported to the appropriate departments and or personnel.
- Oversees and analyzes the OOP yield report to ensure that staff are attempting to meet with the patients and or family members to maximize self-pay collections.
- Understands the data elements required to generate a clean bill; Disseminates daily discharges; Ensures that staff analyze discharges to ensure that LOS is authorized, chart is coded and claim is billed and is in the payer system and will pay at expected reimbursement.
- Ensures that billing packets are scanned and indexed in DocLink correctly and in a timely manner.
- Ensures that all mail pertaining to the Business Office is opened daily and comments are entered in the system for authorization, denials and EOB’s timely, scanned in DoclLnk and filed in monthly Business Office folder.
- Discuss denials with UR staff and update Denial Tracker accordingly. Review EOB’S for potential denials and or refunds.
- Review daily discharge report for potential bridge appointments. When applicable, locate bridge form in chart or nursing station. Fax completed bridge form to appropriate payor, add AIS comments, scan in DocLink, file in monthly folder. If not applicable remove bridge in insurance screen.
- Prepare deposit for any cash or checks received at physical location.
- Ensure that staff is trained to provide backup coverage during breaks and lunches for PBX operator.
- Review AR for overpayments and if applicable prepare patient or insurance refund.
- Request charts, prepare appeals and charts for mailing, documenting Denial Tracker in AIS and scan pertinent documents in doclink.
- Responds to all emails from the CBO for claim resolution in a timely manner.
- Download reports from AIS and work in proper format.
- Participates in activities to enhance professional growth and development.
- Carries out personnel management activities associated with direct staff supervision, including screening and selection, orientation training and development, performance management, and employee relations functions.
- Upholds the Organization’s ethics and customer service standards.
- This job description is not intended to be all-inclusive. Employee may perform other related duties as required to meet the ongoing needs of Reno Behavioral Healthcare Hospital.