Medical Office Specialist

GENERAL DESCRIPTION

The Medical Office Specialist (MOS) is selected by the Medical Billing Manager.  The job duty assigned to the MOS will determine who the supervisor will be. A medical office specialist’s job duties include administrative and patient-interaction services such as registration and eligibility, charge entry and processing of medical claims in order to support the operations of the Center. Perform other duties as required to achieve organizational goals and program objectives.

The Medical Office Specialist function as a member of a collaborative health care team to create and maintain a Patient Centered Medical Home where emphasis is on excellent communication; support of the patient is provided and tracked in a culturally competent, behaviorally enhanced setting supported by information technology.

Due to the nature of NHHC services, it may become necessary to require employees to work extended hours or other variations of the usual shift to ensure adequate care of patients and to maintain services to the community.

CRITICAL JOB ELEMENTS/PERFORMANCE STANDARDS

I.    ELIGIBILITY PROCESS:
•    Interview and register applicants for services at the New Horizon Health Center (NHHC).
•    Acquire all documents required for Sliding Fee Discount determination.
•    Describe consents, agreements, and sliding fee discount process to patients.
•    Capture required data and signatures.
•    Accurately enter demographic data and scan documents into the electronic  practice management system (EPM).
•    Provide patients with pamphlets, disclosures, and sliding fee discount cards.
•    Gather patient insurance cards, verify the insurance then scan it into the (EPM).
•    Explain Obstetric (OB) agreements, acquire the required signatures and provide the Initial Assessment and New OB Physicals.
•    Daily submit payments received from patients to the designated employee in the Finance Department.
•    Answers questions and/or assists the general public on insurance and personal account related matters.

II.    CHARGE ENTRY PROCESS:
•    Enter charges and perform adjustments in the subsidiary ledger utilizing the Electronic (EHR) Manual Charge Processing Pending Report after providers have finalized the office visit note in the EHR.
•    Verifies the diagnosis code (ICD-10) and Current Procedural Terminology (CPT) codes correlate.
•    Communicate with nursing and providers regarding coding discrepancies.
•    Verify and update patient demographic data during the “Check-Out” process.
•    Communicate the financial obligation for services rendered to the patient.
•    Post payment and adjustments if applicable into the (EPM).
•    Discuss and document payment arrangements in the EPM if the patient cannot pay for the office visit on the date of service.

III.    BILLING PROCESS:
•    Verify insurance medical coverage and benefits.
•    Process insurance claims and verify claim submission.
•    Review ERA’s and Explanation of Benefits prior to posting payments for accuracy of reimbursement from insurance companies.
•    Accurately post and balance payment amounts to EPM (Practice Management) within the allotted time and deposits all monies collected.
•    Review Account/Receivable Report and follow-up on unpaid claims.  (i.e., denials, unpaid claims over 30 days, etc…)
•    Review negative account balances and process accordingly.
•    Run daily reports required to perform job duties.
•    Balance daily account financial transactions. Daily submit payments received from patients to the designated employee in the Finance Department.
•    Answers questions and/or assists the general public on insurance and personal account related matters.

IV.    Must attentively greet and be responsive to patients, general public, and employees whether it be in person or over the telephone by demonstrating professionalism, a positive attitude, good eye contact, and a pleasant voice.

V.    Cross-Train among other departmental job duties.

VI.    Miscellaneous and clerical duties and other as required.

VII.    Must maintain confidentiality at all times according to Center policies and HIPAA rules.

VIII.    Must abide by dress code policy in order to maintain a professional and neat appearance. (For details see Employee Handbook dress code policy).

IX.    Abides by the regulations, protocols, and policies as indicated in the NHHC Employee Handbook, Safety policies and Code of Conduct.

X.    It is mandatory that the employees actively participate in Performance Improvement Program.

JOB SPECIFICATIONS

Education and Requirements:
•    High School graduate.  Formal training in Medial Office /Coding required.
•    Fluent in medical billing terminology.
•    Formal training in CPT and ICD-10 coding.
•    Read and understand medical terminology preferred.
•    Familiarity with Microsoft Office applications
•    Valid driver’s license and own transportation preferred.
•    May travel from site to site.
•    Organizational skills, attention to detail and follow-through.

Experience:
•    One to three years experience in filing/processing medical insurance claims in a medical setting strongly desired.
•    Experience in dealing with the general public. Providing customer service.
•    Preferred, one year experience as a cashier in handling money in a high pace setting.

Knowledge, Skills, and Abilities:
•    Excellent Customer Service Skills - Good interpersonal skills, capable to maintain calm under stress, courteous and respectful demeanor.
•    Verbal ability is required to understand written records pertaining to center charges and to discuss them with the patients.
•    Ability to read and understand medical terminology, to read and understand written reports and to abstract pertinent information from records.
•    Numerical ability is required to compile, interpret and utilize reports.
•    Knowledge of general office procedures.
•    Keyboarding and 10 key calculator
•    Ability to communicate orally and in writing in English and Spanish.
•    Ability to establish and carry out specific courses of action.
•    Ability to take corrective action in solving problems, to identify dimensions of a problem, determines potential causes and specifies alternative solutions.
•    Ability to conform to the Center’s established policies and procedures.
•    Ability to maintain a mature attitude while dealing with interpersonal conflict, disruptions, time demands, etceteras.