Location
Bangalore | India
Job description
Follows policy and procedures in regard to financial screening, arrangements and third-party demands 2. Verifies and assures all accounts are ready for billing with adequate supporting documentation, within the established time frames 3. Serves as support to patients and their family members to assure customers have access to all available funding, this involves; working with private as well as governmental agencies; i.e., private insurance, HMO/PPOs, Medi-Cal, Medicare, Champus and Workers Compensation 4. Initiates and completes charity applications on accounts at risk, for completing Medi-Cal application requirements and installment agreements 5. Maintains daily contact with Utilization Management, Business Office, Patient Registration, Medical Records, Ancillary departments, various third-party agencies, HMO/PPOs, patients, their families, physicians, offices and other outside entities 6. Reviews financial data to determine possible Medi-Cal eligibility and verifies with POS/AEVS 7. Assists patients in completing State and county medically indigent application forms and schedules appointments for patients with on-site County eligibility worker 8. Determines possible eligibility for charity assistance, Charity Policy, Proposition 99 Funding, and SB12 9. Prepares accounts for Supervisors approval 10. Bills appropriate state or federally funded programs and follows required procedure for patient eligibility and/or transfer
- Determines patients ability to pay and secure repayment arrangement with patient, according to Oroville Hospital established polices 12. Provides comprehensive audit and analysis 13. Updates all inpatient, outpatient, and surgery accounts to ensure completeness and accuracy 14. Exercises problem solving skills independently and update system to resolve any patient account delay 15. Monitors appropriate turn around on all accounts to ensure the business office within established time frames receives accounts 16. Assures proper financial classification, determines proper guarantor and updates system accordingly 17. Verifies Medicare eligibility utilizing DDE for appropriate coverage relation to service to be rendered 18. Identifies if an HMO or Hospice is managing Medicare benefits 19. Performs third-party certification/verification on Medicare HMO accounts 20. Verifies Medi-Cal coverage for other coverage and restricted services 21. Investigates Medi-Cal overage for other coverage and restricted services 22. Obtains needed authorization for scheduled Medi-Cal accounts requiring 50-1 and forwards to Utilization Management when received 23. Always handles all patient/family contact in a courteous, professional manner 24. Consistently interacts with sensitivity to patients/their families and is responsive to individual needs 25. Receives and places telephone calls in a skillful manner using appropriate etiquette 26. Handles all telephone requests wit courtesy, accuracy and respect for confidentiality 27. Provides estimates for procedures to patients, physicians offices, and payers as requested 28. Consistently follows/reviews third-party guidelines for review notification and contract coding of patient accounts 29. Alerts Supervisor/Director to patterns in problem areas in order to initiate situation resolution 30. Alerts Supervisor if extended payment arrangements are needed to obtain approval from UM Director 31. Reviews each account for specific third-party billing requirements, including necessary document for prompt billing 32. Coordinates necessary activities with external review agents to ensure timely receipt of all thirdparty certification required for billing 33. Review account to assure that all third-party identification codes are used correctly according to documentation in computer system 34. Staff resource to hospital departments for information related to documents and other information necessary for billing
- Contacts referring provider in a timely manner if needed authorization is not initiated on scheduled accounts 36. Utilizes UM Department as a resource for scheduled accounts when authorization cannot be obtained prior to service to determine medical urgency 37. Reviews daily pre-op, surgery and outpatient schedules generated to ensure account information is complete prior to services rendered 38. Obtains necessary referrals, authorization and pre-certifications as needed 39. Obtains patient demographic data not captured during scheduling process, which is necessary for claims processing 40. Determines co-pay, share of costs and deductible status using information obtained during verification process 41. Contacts patient prior to service to advise of OHs policy regarding co-pay and prepares installment agreement, if needed 42. Documents accounting in billing revisions and notes to include verification, authorization, and co-pay to be collected by Patient Registration Representatives at time of procedure 43. Forwards all needed paperwork for outpatient procedures to Patient Registration Representatives to be added to account folder to ensure timely billing 44. Completes and submits a weekly cash collection report 45. Completes and submits a weekly productivity report 46. Demonstrates commitment to total quality management through knowledge of its precepts, skillful workplace applications and continuous organizational improvement 47. Exhibits a customer/supplier philosophy that emphasizes both internal and external relationships 48. Identifies both customer and supplier needs/expectations and strives to exceed them 49. Actively participates in and encourages others to utilize creative and innovative approaches to accomplish tasks 50. Demonstrates responsibility for ongoing personal development, professional growth and continuing education 51. Performs duties in a self-directed manner with minimal supervision or direction 52. Ensures that routine and priority tasks are completed within established departmental time frames 53. Demonstrates a clear understanding of and consistently adheres to department and facility policies and procedures 54. Attends and actively participates in department and facility meeting and classes, including annual fire, safety and disaster programs 55. Follows safety procedures, operates equipment and performs job related duties in a safe manner which prevents accidents from occurring
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