Position Summary: Under the direction of the Assistant Administrator, processes and reconciles patient billings, insurance payments, and postings. Supports all Revenue Cycle activities and ensures associated operations and processes are efficient. Works with payors and outsourced vendors to ensure appropriate processing of claims. Ensures regular payor (provider representatives) meetings are conducted to ensure trends are addressed and individual accounts are resolved. Prepares monthly reports and informs and escalates issues to Assistant Administrator along with recommendations.

Qualifications Requirements:

Minimum Education / Training / Licensure / Certifications:

•  Bachelor’s Degree in Business Administration, Accounting, Finance, or Management and/or equivalent combination of education, training and/or experience

Minimum Experience:

• Two (2) years of progressive revenue cycle experience in health care or ambulatory surgery center.
• Working knowledge of health insurance processing and knowledge of CPT and ICD codes.
• Working knowledge of Microsoft Word, Excel, PowerPoint.

Preferred Education / Training / Licensure / Certifications:

• Course in Medical Terminology.
• Course in billing or medical records or coding.

Preferred Experience

• Experience in billing within Epic environment.
• Experience in billing within SIS.
• Experience in ambulatory surgery center billing, collections, insurance, and payors.

Knowledge, Skills and Abilities:

• Ability to answer telephones courteously.
• Ability to anticipate tasks and prioritize assignments.
• Ability to guide staff and provide direction and assistance.
• Basic math skills.
• Ability to maintain highly sensitive, confidential material.
• Ability to read, write, speak and understand English.
• Ability to input data into computer system.
• Ability to maintain logs.
• Ability to read and maintain medical health records.
• Ability to type at 35-45 words per minute.
• Knowledge of medical terminology.
• Knowledge of personal computers and related equipment.
• Knowledge of standard office procedures.
• Provides hospitable customer service.
• Maintain filing systems.

Working Conditions / Environment:

• Occasional exposure to unpleasant patient or unit elements.
• Subject to many interruptions.
• Occasional pressure due to multiple calls and inquiries.

• Generally good working conditions.
• Little exposure to extremes

Physical / Mental / Special Demands

Required Protective Equipment

• N/A

Patient Care Services

• N/A

Description of OSHA Categories:

OSHA Category:

• Category III

POSITION ACCOUNTABILITIES

Essential Functions

• Support and aids Assistant Administrator in all Revenue Cycle activities at the organization.
• Checks billing data from medical office or hospital records to ensure amounts and account numbers are accurate.
• Prepares invoices, compiling itemized charges, and submits invoices for reimbursement.
• Answers patients’ questions regarding statement and insurance coverage.
• Contacts insurance companies to verify medical insurance coverage for patient and to obtain information concerning extent of benefits.
• Understands and ascertains monthly costs, schedule of medical procedures completed, and type of procedures performed for customers.
• Prepares invoices, compiling itemized charges, and submits invoices for supervisory approval of chards and credit terms.
• Prepares forms for governmental, welfare, and other agencies paying bill of specified patient.
• Submits electronic and paper claims to insurance carriers and verifies eligibility of insurance.
• Posts payments and bills outs medical claims.
• Investigates and communicates with insurance carriers regarding inquiries from patients and patient representatives.
• Reviews and resolves insurance appeals and denials.
• Drafts letters and notices to patients, vendors, and payors as necessary.
• Reviews patient treatment information to ensure proper billing.
• Reviews and resolves delinquent patient accounts.
• Answers patient and insurance representative communication inquiries.
• Reads and interprets explanations of benefits and communicates them effectively to patients.
• May assist in the obtaining of referrals for visits to specialists.
• Prepares customer statements, bills and invoices, reconciles expenses to the general ledger, takes care of basic client inquiries, and performs other clerical tasks related to maintaining the accounts receivable records for the organization.
• Prepares monthly receivable statements.
• Compiles and sorts documents, such as invoices and checks, substantiating business transactions.
• Prepares and posts invoices and credit and debit memos.
• Works with collection personnel to verify status of delinquent accounts.
• May provide backup support to other groups within the organization.
• May type periodic reports and other records.
• Answers and screens phone calls.
• Able to assist and provide direction in medical records, authorizations, billing, patient check-in process, medical chart creation, and verifies accuracy of patient information.
• Reviews incoming requests for patient information in compliance with applicable facility and government policies, procedures, and regulatory requirements/statues.
• Practices effective communication and interpersonal skills to enhance positive teamwork and to accomplish goals/tasks.
• Communicates and reinforces financial policies to all new and established patients.
• Able to sit-in or cover business office staff as needed.
• Promotes excellence in customer/patient relations with all encounters.

• Understands and models Surgicare of Hawaii’s mission, vision, and values.
• Reviews department operations manual to ensure compliance and applicable Joint Commission standards, federal and state regulations, accepted Standards of Conduct and Corporate Compliance Program. Complies with all Surgicare of Hawaii’s policies, procedures, employee handbook and Standards of Conduct.
• Adheres to safety policies and maintains a clean and safe environment for patients and co-workers.
• Participates in departmental and organizational quality improvement efforts.

Other Functions:

• Enhances professional growth and development through participation in educational programs. Current literature, in-service meetings and workshops.
• Performs other related duties as assigned or requested.
• Strive to provide continuous improvement.
• Financially responsible in the workplace.
• Performs other duties as assigned.