Job Description

Department: 70000 Advocate Good Samaritan Hospital - Administration: Ambulatory Services

Status: Full time

Benefits Eligible: Yes

Hours Per Week: 40

Schedule Details/Additional Information:

Major Responsibilities:

• Contributes to department financial goals by performing billing and documentation audits and making corrections when appropriate.

• 1)Reconciles charges using reports and EMR for accuracy
• 2)Work closely with clinical staff to determine appropriate billing for all APC corrections.
• 3)Makes corrections and additions to billing per standard process
• 4)Functions as a liaison between department and provider offices to obtain necessary documentation and information for optimal reimbursement.
• Support and maintain overall functioning of outpatient department(s) supported by role.

• 1)Provides excellent customer service and positively impacts satisfaction scores by demonstrating positive interpersonal skills, keeping multiple customers (internal and external) informed and responding in a timely manner to all methods of communication.
• 2)Actively participates and gives suggestions at department meetings.
• 3)Supports outpt department with all Front Desk standard work
• 4)Answers and directs incoming telephone calls, as needed
• 5)Analyze information to determine "necessity/pertinence" of communicating information to other staff and providers in a timely manner
• 6)Participate in performance improvement projects, department projects and other projects as requested by leadership
• 7)Maintain a list of needed supplies for office areas and assists in ordering supplies listed by other areas of the department
• 8)Coordinate maintenance of area equipment (copier, fax, scanner, etc)
• 9)Direct patient flow to appropriate areas
• 10)Performs additional clerical duties as requested by leadership
• Performs all activities related to third-party payer pre-certification requirements for outpatient services supported by role.

• 1)Verifies per insurance type & service requested for eligibility and the need for pre-certification. Makes referrals to appropriate resources such as Financial Counseling, Business office, etc.
• 2)Reviews orders for completeness and accurate coding
• 3)Completes pre-certification process(es) as appropriate. Upon completion of pre-certification enters and/or communicates authorization information where appropriate Monitors all peer-to-peer certification decisions and closes case with appropriate determination from pre-certification vendor. Monitors future orders and assures completion of pre-certification process by due date of procedure Works with SRCO to provide necessary documentation for any billing, re-billing or appeal needs.
• 4)Upon completion of pre-certification enters and/or communicates authorization information where appropriate
• 5)Monitors all peer-to-peer certification decisions and closes case with appropriate determination from pre-certification vendor.
• 6)Monitors future orders and assures completion of pre-certification process by due date of procedure Works with SRCO to provide necessary documentation for any billing, re-billing or appeal needs.
• 7)Works with SRCO to provide necessary documentation for any billing, re-billing or appeal needs.
• Ensures completeness and accuracy of medical record

• 1)Initiate, maintain and update information in the EMR
• 2)Analyze patient information and diagnosis to determine and obtain information required, as appropriate
• 3)Assign, append, maintain and complete Quality Checklists, as appropriate
• 4)Retrieves patient information from various locations to assist physicians nurse and other providers. Adds new information into the EMR in a timely manner
• 5)Completes clinical summary and e-faxing of documents in a timely manner.
• 6)Audits and corrects discrepancies, when requested
• Registers and schedules patients for services in outpatient department(s) supported by role.

• 1)Registers and Schedules patients using multiple I/S systems and outpatient department templates/guidelines supported by role.
• 2)Updates schedules by adding, cancelling or rearranging schedule to accommodate patient or department needs.
• 3)Obtain, verify and/or update insurance information at initial visit, prior to any treatment and/or with each follow up visit. Follows SRCO processes for decentralized registration and insurance verification.
• 4)Obtains referrals and initiates process for preauthorization\'s, when required
• 5)Explain deposit requirements, refer patient payments to Financial Representative, and refer self-pay patients to Financial Representatives.

Education/Experience Required:

• High school diploma. Five years prior experience in hospital, medical office or medical records environment. Medical billing experience preferred. Knowledgeable in medical terminology.

Knowledge, Skills & Abilities Required:

• Self-directed, minimal supervision required. Experience in statistical preparation, data entry and analysis. Knowledge of multiple medical computer systems. (EMR, scheduling, billing, etc) Excellent written and verbal communication skills required. Experience with general office equipment (i.e. multi-line phone, fax, copier, etc.). Knowledge of CPT, billing guidelines preferred. Good Organizational abilities. Excellent communication and customer relation skills
• N/A

Physicial Requirements and Working Conditions:

• Ability to work with speed and accuracy in fast-paced environment. Ability to prioritize workload. Commitment to customer satisfaction and service excellence. Flexibility in meeting needs of new service that will continue to expand.
• Able to lift up to 20 pounds occasionally and/or 10 to 20 pounds frequently and/or up to 10 pounds constantly

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Advocate Aurora Health is one of the 10th largest not-for-profit, integrated health systems in the U.S. with nearly 3 million patients served at more than 500 sites of care in Illinois and Wisconsin, including 28 hospitals. We\'re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in a variety of specialties. Advocate Aurora Health is one of the 10th largest not-for-profit, integrated health systems in the U.S. with nearly 3 million patients served at more than 500 sites of care in Illinois and Wisconsin, including 28 hospitals. We\'re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in a variety of specialties.

Advocate Health Care