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Account Resolution Specialist

ROLE SUMMARY:
The Account Resolution Specialist is responsible for researching, resolving and collecting on all assigned accounts and performs a variety of medical billing and collection duties under general supervision.

ESSENTIAL DUTIES:

  1. Answer phones and resolve calls accordingly. This will include, but not necessarily be limited to, negotiating payment plans with patients, accepting payments over the phone, updating patient demographics, rebilling insurance and sending tasks to others for further review and follow-up.
  2. Works assigned collection lists.
  3. Researches and resolves claim denial and payment discrepancies by calling carriers, patient and clients, accordingly.
  4. Process all incoming facsimiles, emails, correspondence and voicemails timely.
  5. Complete all tasks received via the Onpoint dashboard, daily.
  6. Abide with HIPAA and PHI guidelines at all times.

SKILLS, KNOWLEDGE, AND ABILITIES:

  1. Excellent verbal, written and interpersonal communication skills.
  2. Proficient with Windows, MS Office, Google Drive, email and multiple web browsers.
  3. Excellent organization skills and attention to detail
  4. Demonstrates an independent work initiative, sound judgment and strong work ethic.
  5. Ability to handle multiple tasks simultaneously
  6. Experience with AMD practice management software a plus but not required.

MINIMUM REQUIREMENTS:

  1. High school diploma or GED
  2. One year of experience in a health care setting, preferably with accounts receivables.

The above statements are intended to describe the general nature and level of work performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified and employees may be required to perform other duties as assigned.

Receptionist

ROLE SUMMARY:
The Medical Billing Receptionist is responsible for a variety of functions in a busy medical billing office.  The position supports all departments and the office environment.  This position performs a variety of clerical duties under general supervision.

ESSENTIAL DUTIES:

  1. Incoming mail.
    1. Process all incoming mail and prepare for posting.
    2. Update returned patient mail address’ and or carrier remit to address’
  2. Outgoing mail
    1. Fold, Stuff and stamp outgoing mail in a timely manner
  3. Maintain unapplied payments, both insurance and patient.
  4. Answer phones and resolve calls accordingly.  This will include, but not  limited to, negotiating payment plans with patients, accepting payments over the phone, updating patient demographics and information insurance and sending tasks to others for further review and follow-up.
  5. Process and distribute missed calls, voicemails and facsimiles as appropriate and timely.
  6. Make past due phone calls, schedule follow up and document actions taken on patient accounts.
  7. Scan paper work and process as directed.
  8. Complete all tasks received via the Onpoint dashboard, daily.
  9. Purchase and stock supplies for the office as needed and approved by supervisor
  10. Keep a friendly and clean office.
  11. Other special projects suck as data entry, data corrections, edits and updates as assigned.
  12. Abide with HIPAA and PHI guidelines at all times.

SKILLS, KNOWLEDGE, AND ABILITIES:

      1. Excellent verbal, written and interpersonal communication skills.
      2. Proficient with Windows, MS Office, Outlook and Chrome as well as other web browsers.
      3. Excellent organization skills and attention to detail.
      4. Demonstrates an independent work initiative, sound judgment and strong work ethic.
      5. Ability to handle multiple tasks simultaneously
      6. Experience with AMD practice management software a plus but not required.

MINIMUM REQUIREMENTS:

    1. High school diploma or GED
    2. One year of experience in a health care setting preferred.

The above statements are intended to describe the general nature and level of work performed by people assigned to this job.  They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel and employees may be required to perform other duties as assigned.

Medical Billing Specialist

This Position has been filled.

ROLE SUMMARY:
The Medical Billing Specialist is responsible for a variety of billing functions that support all departments and performs a variety of duties under general supervision.

ESSENTIAL DUTIES:

  1. Primarily responsible for supporting the Posting and Claim Center departments to include but not limited to.
    1. Posting the payment and non-payment remittances of all patient and insurance transactions both electronic and paper, as instructed. Research of items in efforts to post with 100% accuracy may require extensive online and phone communications.
    2. Resolve all claims inspector edits, unbilled and exclusion errors making necessary corrections to claims and the accounts affected including but not limited to demographics, charge codes, fees, referrals, authorizations and corrections to posting, in a timely manner, as instructed. Resolution will require an extensive background in medical coding. The use of coding edit tools and websites will be required.
  2. Responsible for other department support as needed which may include but not limited to sorting mail, calling on patient balances, assisting credentialing and following up on paperwork, filing, indexing and working collections correspondence. All will require a high level of documentation recorded within our online systems.
  3. Answer phones and resolve calls accordingly. This will include, but not necessarily limited to, negotiating payment plans with patients, accepting payments over the phone, updating patient demographics, rebilling insurance and sending tasks to others for further review and follow-up.
  4. Complete all tasks received via the Onpoint dashboard, daily.
  5. Abide with HIPAA and PHI guidelines at all times

SKILLS, KNOWLEDGE, AND ABILITIES:

  1. Excellent verbal, written and interpersonal communication skills.
  2. Proficient with Windows, MS Office, Outlook and Internet Explorer.
  3. Computer and keyboard skills are a must.
  4. Excellent organization skills and attention to detail
  5. Demonstrates an independent work initiative, sound judgment and strong work ethic.
  6. Ability to handle multiple tasks simultaneously
  7. Experience with AMD practice management software a plus but not required.

MINIMUM REQUIREMENTS:

  1. High school diploma or GED
  2. Two year of experience in a health care setting, preferably with accounts receivables. The above statements are intended to describe the general nature and level of work performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel and employees may be required to perform other duties as assigned.

How to Get Paid for Incident to Billing

Employing a non-physician practitioner (NPP) e.g. physician assistant or nurse practitioner has many benefits.  It increases patient through-put, enhances the patient experience and increases a practice’s revenue.  Once the NPP is hired, we are many times asked what is “incident to” billing and when does it apply.

Simply put, incident to billing applies only to Medicare and allows the NPP to be reimbursed at 100% of eligible charges.  If incident to billing is not utilized, then the NPP will be reimbursed at 85%.  The specific requirements are detailed in Chapter 15, Section 60 of the Medicare Benefit Policy Manual.

So, what are the rules for incident to billing?  There are some basic rules and all must be met to meet the incident to rules for Medicare payment.

  1. Services must be rendered in a setting other than a hospital or skilled nursing facility. The Centers for Medicare & Medicaid Services (CMS) refers to this as non-institutional settings.
  2. A physician who is Medicare-credentialed must initiate the patient care. The NPP cannot see the patient for the first visit or if a change in the treatment plan is needed.
  3. Both the physician and the NPP must be employed by the entity that is billing for the service. If the physician is a solo practitioner, then the physician must employ the NPP.
  4. Follow-up care can be rendered by the NPP provided they are under the direct supervision of a Medicare-credentialed physician. Direct supervision requires that the physician be a part of the same group, but not necessarily the physician who performed the initial patient evaluation, be present in the same office suite and immediately available to help during the time the NPP is rendering patient care.
  5. Pursuant to the physician’s state licensure rules, they must actively participate in and manage the patient’s treatment.
  6. The service provided must be routinely provided in the office setting and are of a type considered medically appropriate to provide in the office setting. Incident to billing does not apply to services that have their own benefit category, such as diagnostic testing.
  7. Documentation should include who performed the service and who was the supervising physician.

Transitioning to a New Medical Billing Company

You’ve chosen a new medical billing company but now the reality of the transition begins to weigh heavy on you.  The first thing to do is work with your new medical billing company to devise a transition plan.

The plan should clearly identify what will be done and who will do it.  Some medical billing companies already have a tried and true transition plan that they will lay out for you.  If your new medical billing company provides this type of direction, then you are way ahead and the transition will likely be fairly smooth.

One of the key things that needs to be done immediately is to re-credential the provider(s) with all insurance carriers.  This is a critical path and some carriers may take as long as 90 days to update their records.  Therefore, it is crucial that this process be started immediately.

Most practices have old AR that needs to be cleaned up.  There are some medical billing companies that will take over the old AR but most don’t like to because they are dealing with another biller’s mistakes, poor documentation and missing information.  You can, however, ask your new medical billing company if they are willing to take it over.  If they do, expect to pay a higher fee since it involves significant resources on their end.

There are some practices that have chosen to change billing companies but feel the current biller can close out the old AR.  If your practice falls into this category, then you will have your current biller work the old AR while the new billing company works all current claims.  The key thing is to pick a cut-over date and stick to it.  Undoubtedly, the carriers will send reimbursements to the wrong billing company so it is imperative that a line of communication be established between the two entities.  They will need to share information in order for the old billing company to close out the AR.

Generally speaking your new billing company will carry out the entire transition plan.  They will set up the clearinghouse, process all EDI and ERA applications, handle the re-credentialing and train your staff.  If they don’t provide these services, then make sure you know who will be handling every aspect of the transition.  You can’t afford for anything to fall through the cracks.

During the transition, it is a good time for you to consider what operational changes may be necessary in your office so that workflow is as efficient and accurate as possible.  No matter how good the billing company is they can’t collect on your accounts in a timely manner unless they have accurate and complete demographics, pre-authorizations in place and the insurance coverage has been verified.  You need to let your staff know who is accountable for these critical tasks.  This may be a real change for your office.  Your staff may take issue with these changes but the alternative is that collections will suffer, cash flow will be negatively impacted and your practice could fail.  So change is really the lesser of two evils and the path you must choose. The first step is the hardest and a well-conceived transition plan will definitely be a step in the right direction.