Business Office Specialist

Primary Responsibility:

The Business Office Specialist ensures that all billing information, including demographics and insurance data, is accurately entered in the patient chart and that all requirements of the coverage in place are met. Meets and advises PSR staff regularly regarding information collected and insurance changes/requirements. Reviews daily charge entry and corrects as necessary. Collects and enters surgical charges in a timely fashion. This position requires working patiently, efficiently and accurately to ensure an optimal patient experience.

Additional Roles and Responsibilities:

Ensures that all patients are greeted in a friendly and professional manner.

Ensures that all patients are registered in a timely manner with the appropriate demographic information and insurance information entered into NextGen practice management system.

Verifies all patient encounters include necessary provider signatures.

Conducts patient consultations to review and answer questions related to financial policies and out-of-pocket costs for surgery as needed.

Applies modifications/corrections as needed prior to charges being submitted to clearing house.

Audits and reviews schedules for upcoming dates of service to verify RTS eligibility, Intelichart registration, referrals, and all fields entered by patient registrars.

Verifies charges for testing and coding.

Reviews patient charges and performs daily payment reconciliation to ensure co-pays and referrals are collected and posted into the system in an accurate manner.

Ensures that the patient's insurance has been verified and any necessary referrals and/or authorizations are obtained prior to being seen. Alert manager to any problems with a patient's coverage and jointly decide if the patient must pay for services or reschedule their appointment. Registrar will always take into consideration the medical urgency of a patient's condition when making this determination.

Ensures that the physicians and residents have signed the charts prior to entering any charges.

Makes appropriate appointments for the patient by carefully reviewing the physician's instructions on when and where to follow-up. When there is confusion, seek out a physician or manager for clarification.

Communicates with the technicians as necessary to service a patient's needs.

Travels when necessary to other Wills Eye locations as required by physician scheduling.

Understands insurance terminology and educates patients on insurance challenges and alerts patients to the need for referrals, etc.

Initiates and manages clinical authorizations or patients.

Provides counseling to patients and/or providers by answering benefit questions, researching and resolving insurance issues and inquiries and enhances patient and providers understanding of insurance coverage and financial responsibility on in-office procedures

Acts as a liaison between physicians, health plans, vendors, patients and referral sources for planned and unplanned procedures.

Responds to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions.

Assists patient registration team as needed.

Uses good judgment and initiative, communicates effectively and adapts to variations in workloads, assignments and interpersonal situations as needed.

Respects and protects the patients' rights to confidentiality and privacy and discloses information only for professional purposes, which are in the patients' best interest with full consideration of their legal rights.

Formulates and maintains effective working relationships with peers, management, and functions as an effective team member.