Position Summary: This position is responsible for ensuring all insurance and pre-collection requirements are met prior to patient’s surgical and/or office procedures and to inform patients of their financial responsibility. Additionally, this position is responsible for communicating patient financial liability, establishing payment plans, and processing delinquent patient accounts to external collection agencies.

Responsibilities/Accountabilities:

Pre-Collect and Good Faith Estimates:

1. Communicate with patients, face-to-face or by telephone, collecting on patient financial liability in advance of medical services being performed.
2. Review and verify insurance benefits for all proposed or scheduled procedures.
3. Review and verify insurance eligibility for scheduled patients.
4. Review patient account ledgers and contacts patient to initiate pre-collection procedure.
5. Calculate and collect payments appropriately for all patients.
6. Perform price estimates for medical services using price estimate technology and insurance company portals to obtain procedure claim estimates and calculate patient responsibility.
7. Accurately completes good faith estimates in the required timeframes.
8. Communicates with patients in a compliant and professional manner.
9. Establish down payment and payment plan requirements prior to clinic staff scheduling all elective procedures.
10. Complete pre-collection on accounts promptly and efficiently to reduce patient receivables and bad debt.
11. Perform duties necessary to ensure all accounts are processed accurately and efficiently.
12. Perform other duties as assigned by the Supervisor.

Collections:

1. Communicate with patients, face-to-face or by telephone, collecting on patient financial liability.
2. Process patient accounts promptly and efficiently to reduce receivables and bad debts.
3. Monitor payment plans for adherence to defined payment plan guidelines.
4. Review patient account ledgers and contacts responsible parties to collect monies on delinquent accounts.
5. Participate in automated telephone work queue collecting on past due balances.
6. Place delinquent accounts with collection agency.
7. Consult with patients regarding their financial responsibility, current benefits, and limitations on coverage for their plan product and payment options.
8. Review and process bankruptcy paperwork.
9. Review and process deceased patient accounts.
10. Performs other duties as assigned by the supervisor.

Customer Service and Communications:

1. Communicates with patients, insurance carriers and other outside entities in a professional manner. Identifies solutions and responds professionally to patient concerns, i.e., pleasant tone of voice, courteous language, etc. Uses appropriate grammar and demonstrates tact and diplomacy in patient interactions, by phone and in person.
2. Diffuses negative situations with patients and maintains a pleasant and professional tone during stressful circumstances and heavy workload.
3. Communicates with staff members in a professional, pleasant manner; Shares information relevant to work, no gossiping or disparaging remarks, accepts work without complaint or provides reasons why assignment is unmanageable, asks and answers questions related to improving department performance.

Teamwork:

1. Works cooperatively with coworkers, providers, and management.
2. Shares knowledge and insights with co-workers in a constructive manner.
3. Willingly provides coverage to department, staying beyond scheduled ending time when clinic schedule demands it, volunteering to cover time off or unexpected absences, maintaining workflow in department without direct supervision.
4. Addresses conflicts with person directly before involving manager or uninvolved peers.
5. Is considerate of others with regard to taking breaks or meal periods, use of computer and telephone, and noise in department

Policies and Procedures:

1. Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.
2. Provides assistance and support to leadership in implementing policies and procedures as necessary.
3. Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.

Education, Experience, and Certification/Licensure Required: High school diploma/GED required and some post-secondary education is preferred. This position requires a minimum of 2 years of previous medical billing/collections experience in a medical office or insurance payer setting. Experience in healthcare patient accounting or revenue cycle department, including knowledge of insurance deductibles, co-insurance, and price estimate processes is also required. Previous experience working in an electronic medical record system is essential. Knowledge, Skills, and Abilities:

Able to organize and prioritize responsibilities; Demonstrated ability to work independently, with little immediate supervision; Understanding of basic mathematical principals; Knowledge of CPT, ICD-10 and HCPCS codes; Ability to communicate using appropriate professional grammar, tact and diplomacy; Basic computer skills and comfortable working with Microsoft Office programs; Excellent customer service and communication skills; Able to diffuse stressful situations and maintain a pleasant and professional tone during these circumstances; Able to work effectively with all levels of staff, management and physicians.