Business Office Coordinator - Metro Health Outpatient
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- Comstock Park, MI
- Mary Free Bed Rehabilitation Hospital
- Metro - Coms Park
- Full-Time - Days - 8a-5p, working Monday to Friday
- Posted: November 15, 2019
We have the great privilege of helping patients and families re-build their lives. It’s extraordinarily meaningful work and the reason we greet the day with optimism and anticipation. When patients “Ask for Mary,” they experience a culture that has been sculpted for more than a century. Our hallmark is to carefully listen to patients and innovatively serve them. This is true of every employee, from support staff and leadership, to clinicians and care providers.
Mary Free Bed is a not-for-profit, nationally accredited rehabilitation hospital serving thousands of children and adults each year through inpatient, outpatient, sub-acute rehabilitation, orthotics and prosthetics and home and community programs. With the most comprehensive rehabilitation services in Michigan and an exclusive focus on rehabilitation, Mary Free Bed physicians, nurses and therapists help our patients achieve outstanding clinical outcomes. The growing Mary Free Bed Network provides patients throughout the state with access to our unique standard of care.
Restoring hope and freedom through rehabilitation.
Diversity and Inclusion
Mary Free Bed values diversity and inclusion among patients, families and staff. We strive to hire people who reflect the communities we serve. Our employees will serve all patients, families and each other with dignity and respect.
Accurately collects information from multiple sources to process referrals for outpatient therapy. Analyzes and records the required demographic, insurance, and clinical data sets, other information, and signatures necessary to schedule and pre-register outpatient therapy patients and ensure that bills are produced according to regulatory and payer requirements. Effectively completes medical necessity and managed care requirement screening, and determines insurance type and eligibility to ensure maximum payer compliance is maintained and maximum reimbursement is secured. Verifies and/or authorizes insurance as assigned. Interacts in a customer focused manner during referral processing to ensure that the patient’s and their representative’s needs are met, and that they understand their personal liabilities through various payment and program options. Demonstrates complete understanding and knowledge of all processes and procedures related to insurance verification, insurance prior authorization, and registration. Performs all insurance verification and communicates appropriate verbal and written explanations to patients, family members, and/or other appropriate parties. Assists in prevention of retroactive denials. Works cooperatively with other departments and outpatient staff/leadership to assure financial reimbursement for outpatient therapy services.
Essential Job Responsibilities:
- Accurately collects and analyzes all required demographic, insurance, guarantor and clinical data elements necessary to process/pre-register outpatient therapy referrals and schedule all types of patients; records and electronically enters the information on a timely basis. Verifies and/or authorizes insurance.
- Accurately prepares, produces, and distributes to other internal and external parties as appropriate and on a timely basis, forms, schedules, and supportive clinical documentation.
- Reviews physician referrals/orders and other documentation according to internal policy and regulation as applicable, in order to assure that the service being provided has been appropriately documented and meets all known payer medical necessity and other criteria. Initiates contact to physicians and other office staff to resolve questions and problems. Initiates and explains the Advance Beneficiary Notification process as necessary. Alerts appropriate parties for any ongoing monitoring or authorization needs.
- Provides information and explanations to the patient or responsible party regarding the policy and various options for resolving the patient’s financial responsibility for non-covered services prior to the service being provided.
- Receives and properly responds to telephone, electronic, or face-to-face inquiries from patients or their representatives.
- Reviews and analyzes all referral information and transaction edit reports in order to correct errors and resolve deficiencies.
- Accurately completes therapist planned/unplanned coverage per department protocol.
- Performs all other appropriate activities as necessary to meet the patient’s needs and to achieve the required departmental and organizational outcomes. Assists patients/families in keeping scheduled evaluations by providing transportation resources and/or securing translators as necessary.
- Accurately interprets referrals and patient scheduling communication sheets and develops ongoing outpatient therapy schedules. Assures therapist consistency, accuracy, and timeliness when producing schedules according to established scheduling guidelines. Reschedules appointments as needed.
- Reviews notes and other documentation according to internal policy and regulation as applicable, in order to ensure that a treatment prescription and authorization has been received to support scheduling of ongoing therapy appointments.
- Provides information and explanations to the patient or responsible party regarding status of scheduling or non-scheduling of outpatient therapy evaluation or treatment appointments according to notations and/or protocols.
- Initiates electronic and/or telephone inquiries to the appropriate parties including third party payers, employers, and/or managed care organizations, sharing information as necessary in order to secure, record, and electronically enter data which confirms that the patient has been initially authorized for the service being provided.
- Analyzes the available documentation and uses software and/or other listings or information, including the data gathered during the third-party eligibility and benefit verification, in order to calculate the amounts expected to be received from the payer and the amount owed by the patient or his/her responsible party.
- Provides pre-appointment telephone explanations to patients and other appropriate parties. Ensures that the patient or representative understands the policies that govern the revenue cycle and provide various options for resolving the calculated patient financial responsibility for non-covered services.
- Negotiates with the patient or responsible party to achieve a mutually acceptable resolution of the expected self-pay balance including such options as credit card payments, deposits, extended/external payment arrangements and screens for and initiates charity care. Refers the patient or responsible party to other internal or external sources as applicable. Initiates contact to physicians and other office staff as necessary to resolve questions and problems.
- Accurately generates patient specific Explanation of Benefit Forms and distributes to patients/representatives and appropriate internal parties on a timely basis.
- Enters calculated expected patient co-pay and co-insurance amounts in Cerner. Sets follow-up dates in Share Point to monitor out-of-pocket maximums to determine amounts met. Updates Cerner and Share Point notes accordingly.
- Completes timely posting of cash collections, accepting and generating appropriate receipts for monies and credit card payments received.
- Handles appointment cancellation requests from patients in the event insurance coverage is not available and reschedules appointments as appropriate. Completes the return-to-doctor communication process in the event the patient decides not to receive services.
- Collects, Compiles, analyzes, and reports data requested by manager.
- Provides clerical support as requested.
- Various other responsibilities delegated by manager.
Essential Job Qualifications (Knowledge, Education, and Training Requirements)
- Associates Degree or equivalent business classes/experience
- Minimum 12-18 months work experience in healthcare with scheduling and/or PFS related job duties.
- Demonstrated competency with ICD-10-CM and CPT coding classification systems.
- Outstanding organizational, interpersonal, communication, and overall customer service skills.
- Ability to interact with professional staff in an appropriate manner.
- Knowledge of medical terminology and clinical rehabilitation.
- Ability to perform in a high paced environment with a positive attitude.
- Physical Demands: Able to exert up to 10 pounds of force occasionally (up to 1/3 of the time);
- able to lift, carry, push, pull, up to 10 pounds occasionally; able to sit for the majority of the time, but may involve brief periods of time involving walking or standing; able to use keyboard frequently (1/3 to 2/3 of the time).
Other Preferred Job Qualifications:
- Completion of medical office course.
- Bachelor’s Degree in a health-related field
- Certification as a Medical Assistant or Licensed Practical Nurse
Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, genetic information, veteran status, disability or other legally protected characteristic.