Description of Position:
Provide a “snapshot” or the principal purpose or focus of the position, consisting of no more than three to five sentences. This summary should provide enough information to differentiate the major function and activities of the position from those of other positions.
Under guidance and supervision, the associate performs reception, billing, scheduling, charge and data entry, insurance pre-authorization, verification and benefit coordination, filing, record keeping and other duties for one or more areas within Physical Medicine and Rehabilitation. The associate is expected to acquire an understanding of, and proficiency in all functions for their assigned area. Demonstrates initiative and sound judgment in the application of policies and procedures.
Essential functions are the duties and responsibilities that are essential to the position (not a task list). Do not include if less than 5% of work time is spent on this duty. Be specific without giving explicit instructions on how to perform the task. Do not include duties that are to be performed in the future. Duties should be action oriented and avoid vague or general statements.
% of Time
- Receives patients and visitors and answers telephone; screens calls and callers, referring them to the appropriate person.
- Creates a welcoming environment for person’s served. Effectively manages positive relationships with referral sources and other members of the team.
- Schedules all patient appointments.
- Coordinates all modifications to patient schedules, including reschedules, cancellations, no-shows and discharges.
- Manages providers calendars.
- Verifies insurance eligibility and insurance coverage for assigned department(s) via phone or internet. Contacts patients prior to first appointment and counsel’s patient on coverage. If unable to contact patient prior to first appointment, counsels them when they arrive for first appointment. Documents in account notes in EPIC.
- Gathers billing information for patients with worker’s comp insurance (employer demographics, responsible billing party, billing address) and coordinates authorization for services.
- Manages and coordinates pre-authorizations for services as needed. Sends requested documentation to third party payers for prior authorization and reauthorization of patient visits.
- Coordinates Price-line requests for estimate of cost for the patient.
- Counsels patients on process for estimates of their payment for therapy, prompt pay, and financial assistance applications.
- Reconciles daily patient attendance and charges posted with revenue/usage reports.
- Responds to patient’s questions regarding their account and ensures solutions to patient billing, complaints or concerns.
- Demonstrates ability to effectively manage details by accurately completing registration/referrals, maintaining medical records, and charge correction.
- Collects payment as needed
- Monitors and completes accounts on multiple work queues in EPIC, including referrals and denials.
- Problem solves, analyzes and collaborates with patient, therapist, Central Billing Office, Revenue Cycle department, and insurance companies to identify and resolve billing and denial issues, including sending appeals and trouble- shooting and correcting claim or account errors.
- Documents denials and billing issues to identify processes that need improvement in order to maximize efficiency and ensure proper payment within the department.
Daily and/or weekly duties:
- Creates and modifies documents using word processing and spreadsheet computer programs.
- Maintains designated filing and record keeping systems. Assists with preparation of reports, graphs, and statistical information.
- Orders supplies for department.
- Serves as payroll timekeeper for assigned departments.
- Performs other related secretarial and clerical functions as requested.
Basic UPH Performance Criteria
- Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
- Demonstrates ability to meet business needs of department with regular, reliable attendance.
- Employee maintains current licenses and/or certifications required for the position.
- Practices and reflects knowledge of HIPAA, CARF, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
- Completes all annual education and competency requirements within the calendar year.
- Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.
Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
Demonstration of UPH Values and Standards of Behaviors
Consistently demonstrates UnityPoint Health’s values in the performance of job duties and responsibilities
- Leverage the skills and abilities of each person to enable great teams.
- Collaborate across departments, facilities, business units and regions.
- Seek to understand and are open to diverse thoughts and perspectives.
Own The Moment:
- Connect with each person treating them with courtesy, compassion, empathy and respect
- Enthusiastically engage in our work.
- Accountable for our individual actions and our team performance.
- Responsible for solving problems regardless of the origin.
- Commit to the best outcomes and highest quality.
- Have a relentless focus on exceeding expectations.
- Believe in sharing our results, learning from our mistakes and celebrating our successes.
- Embrace and promote innovation and transformation.
- Create partnerships that improve care delivery in our communities.
- Have the courage to challenge the status quo.
Identify items that are minimally required to perform the essential functions of this position.
Preferred or Specialized
Not required to perform the essential functions of the position.
Must be at least a high school graduate
- Prior secretarial experience in medical environment
- Prior insurance knowledge
Valid driver’s license when driving any vehicle for work-related reasons
- Writes, reads, comprehends and speaks fluent English
- Multicultural sensitivity
- Microsoft Office and Outlook – basic computer skills
- Customer/patient focused
- Critical thinking skills using independent judgment in making decisions
- High organizational skills
- Ability to multi-task
- High attention to detail
- Experience with medical insurance processing
- Medical terminology
- Use of usual and customary equipment used to perform essential functions of the position
- Work may occasionally require travel to other UPH facilities. May drive a UPH vehicle, rental or own vehicle
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