Job Description

							                                      Job Description
JOB TITLE: Patient Account and Insurance Specialist

DEPARTMENT: Business Office

POSITION REPORTS TO: Business Operations Director and
                      Patient Account and Insurance Specialist Team Leader

TEAM MISSION STATEMENT:
To maintain the highest level of proficiency and accuracy to maximize reimbursement and to
provide billing/insurance information to customers inside and outside of SCO in a timely,
courteous, and knowledgeable manner.

JOB SUMMARY:
The individual in this position will process and distribute claim forms on paper and electronically,
reviewing them for accuracy and completeness; process and distribute accurate patient
statements; review delinquent patient accounts and make recommendations for resolution;
coordinate preparation of reports and other documentation request by patients, attorneys,
insurance carriers, etc.; perform a critical public relations function of providing pleasant,
knowledgeable verbal and written representation of the clinic in all daily business contacts.

TYPICAL PHYSICAL DEMANDS REQUIRED:
Work requires the ability to ambulate, bend, stretch and lift. Requires manual dexterity for use of
a calculator and computer keyboard. Requires lifting and carrying of items weighing up to 50
pounds. Exceptional knowledge of computers required. The ability to hear, see and speak within
normal range. Requires sitting for long periods of time, working in an office environment. Must
be able to function under stressful conditions with strict deadlines.

JOB DUTIES:

Essential:

General Duties
       Prioritize work assignments, ensure on-time completion of tasks and projects and provide
        timely updates to the Business Operations Director and Insurance and Prior-
        Authorization Team Leader.
       Other duties as assigned.

Business Office Duties
       Review EOBS for accurate posting entries, billing amounts and reimbursement.
       Posts all actions taken related to a patient's account into the patient's computer chart in
        order to maintain a permanent, accurate record of the action taken in the overall
        processing of the account.
       Process and submit insurance claim forms (electronically and on paper). Analyze reports
        and forms for completeness.
       Generate weekly statement processing.
       Review denials. Analyze to identify patterns of denials and communicate trends and
        recommendations for change to management.




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                                                                                      Modified: July 5, 2007
       Responds and follows through incoming calls from patients, insurance carriers and third-
        party payers. Identify and resolve issues regarding claim processing, complaints and
        billing.
       Evaluate patient financial status and establish budget payment plans.
       Secure prepayment or financial agreements prior to providing service of patients
        according to clinic policy
       Identify delinquent accounts and perform collection actions on those accounts including
        contacting patients by telephone and letter, coordinating physician review making
        recommendations for resolution, and instituting collection plans according to clinic
        procedures.
       Balance transaction register daily, generate bank deposit slips and forward to Finance
        Director for daily bank deposits
       Process daily correspondence, coordinating thorough completion of reports and other
        requests from attorneys, insurance companies, patients, employers, etc.
       Prepares appropriate documents and forwards to proper personnel in order to make
        adjustments to a patient's account.
       Post clinic and surgery charges according to physician responsibilities.
       Post payments according to schedule of responsibilities, manually and electronically.
       Process mail return statements and updates accounts accordingly.
       Process refunds according to clinic policy.
       Cross train to post other clinic/surgery charges during periods of vacation or illness.
       Adheres to SCO clinic financial policies and procedures as well as the Fair Debt
        Collection Act.
       Other duties as assigned.


Other Duties
       Provide information updates to clinic personnel.
       Provide structured reporting as required.
       Transfer of collection accounts to the agency.
       Process adjustments and account collections.
       Keeps inventory of supplies associate with forms, envelopes, etc.
       Work as team member to continually assess and improve business office functions
        throughout the team and the clinic.
       Attend team or staff meetings as required.
       Participate in committees as requested.
       Maintain strictest confidentiality. Deal discreetly with large amounts of sensitive,
        confidential information.
       Other duties as assigned.

QUALIFICATIONS:

Essential:

       Education: No formal education required.
       Experience: Minimum of one year of business office experience, preferably in an
        orthopaedic or medical clinic.
       Knowledge of legal and regulatory provisions related to collection activities.
       Knowledge of medical insurance and third party reimbursement procedures and
        practices.

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                                                                                      Modified: July 5, 2007
        Knowledge of medical terminology.
        Ability to perform mathematical computations.
        Skill in exercising a high degree of initiative and judgment.
        Ability to work under strict deadlines and stressful situations.
        Ability to handle stress calmly.
        Maintain professional attitude and appearance.
        Excellent communication and interpersonal skills.
        Excellent organizational skills.
        Excellent customer relations’ skills, internal and external.
        Excellent computer/keyboarding skills.
        Ability to plan, prioritize and organize workload under strict deadlines.
        Must be flexible and reliable.
        Must embrace innovativeness.

CREATION DATE: September 12, 2005
Modified: December 27, 2005
Modified: February 27, 2006
Modified: July 5, 2007



APPROVED BY




St. Croix Orthopaedics, P.A.




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                                                                                       Modified: July 5, 2007