Clinical Business Office Representative

General Statement of Duties

A. PRIMARY PURPOSE OF THE ORGANIZATIONAL UNIT:

The Nash County Health Department consists of the Nashville headquarters office, the Rocky Mount branch office, with both including WIC offices, and the Case Management programs office located on the UNC Nash Hospital campus in Rocky Mount. The local Human Services Board serves as the governing board for the health department. The staff is charged with the responsibility of offering better health care with emphasis on education and prevention and environmental protection of the citizens of Nash County.

B. PRIMARY PURPOSE OF THIS POSITION:

The primary purpose of this position is to interview all clients to determine financial eligibility and third-party providers. Determine fee for service and collect money and/or discuss payment plan. Bill Medicare and other third-party providers.Determine if Maternal Health client is eligible for presumptive Medicaid.Review Explanation of Benefits and Remittance Advise, then resubmit claims as needed.Maintain accounts receivable data including a statement of receipts and charges on a daily basis.

Essential Duties and Tasks

A. PUBLIC CONTACT

Interview clients, secure documentation and verify financial eligibility for each program.Verify Medicaid or private Insurance at the time of service, making copies as necessary for documentation.Enter insurance information and bill for services rendered.Update financial information in the EHR (Patagonia Health Systems) and have the client to sign a declaration and/or payment agreement.Determine presumptive eligibility on new maternity patients.Handles calls from the public about income-based fees.Contacts insurance providers in reference to billing/payment questions.

Answer numerous daily questions from switchboard calls for information related to day-to-day health related services.

Contact with Department of Social Services for the process of approving patients for Presumptive Medicaid and the financial counselors at Nash UNC Health Care inquiring about our patient’s sources of payment.Provide BCCCP authorizations for mammogram and breast ultrasound appointments.

Promote patient awareness of insurance, Family Planning Waiver, and clinics that offer community-based services to meet the patient’s needs that are not available through the local health department.

Responsible for cross-training with co-workers in duties and functions of the Business Office.

B. RECORDS AND REPORTS:

Determines financial eligibility for all program services and records information in the patient’s chart.The sliding fee scale provided by the Division of Public Health along with income and the number in the household determines fee for services.Responsible for establishing patient payment plans.Enters visit data per CPT/ICD-10 codes in the computer for direct billing to the patient and/or third-party provider.Receives payment and applies to the appropriate account.Prepares end of the day report of charges and fees collected per program.Provides daily cash report to the administrative staff in the Nashville health department and the finance office.Prints End of Period Monthly Report for both offices.Mails statements on a monthly basis and prepares bad debt report per agency guidelines.

Receives mail from other health care providers, disability determination office, etc. and processes information as per guidelines.

Ensures that patient demographics are updated at each time of service.Ensures proper information is entered into computer for maintenance of records, reports, statistical data and for purpose of meeting all program requirements.Ensures that each superbill/encounter form is returned to the Business Office.The Patient Relations Representative then records and bills all components using the ICD-10 and CPT codes provided by clinical staff.

Compiles list of uncollectible accounts for submission to the North Carolina Debt Set Off according to agency’s policy.Responsible for posting payments received from the North Carolina Debt Set Off Program.Compiles bad debt write off list according to the Bad Debt Write Off Policy.

Responsible for accounts receivable for all outside payors (Health fair, Industry screening, Emergency Management Services, school personnel etc.).

Reconciles Lab Corp statement on a monthly basis for various programs to be charged.Assess if charges are correct, and then match with lab slip to ensure patient received services.

Periodically receive from UNC-Chapel Hill request for proof of Medicaid and eligibility for indigent funds for certain lab test for maternity patients.

C. OTHER DUTIES:

Performs other duties as assigned.

D. SUPERVISION RECEIVED:

Performs duties independently with guidance from the supervisor as needed.

E. RESOURCE AND GUIDELINE AVAILABILITY:

Agency policies and procedures for clinical services and administrative support are available.

Knowledges, Skills and Abilities

Good working knowledge of all departmental activities, especially maternity program, other agency personnel and other healthcare providers.Ability to interpret and adhere to established policies and procedures and follow written and verbal instructions.Extensive knowledge of good office practices and procedures.

Considerable ability to speak and communicate effectively, possess perceptive interviewing skills and the ability to ascertain specific information and translate it into a usable form.

Considerable knowledge of accounting principles and practices, third-party reimbursement rules and regulations, agency policies and procedures, especially as they relate to fee collections, billing procedures, and accounts receivable.

Unimpaired mental concentration and visual acuity is required to accurately complete the required duties of the position.

Manipulative skills as necessary for operation of the calculator and the computer for computing accounts, entering and retrieving data, and filing and retrieving charts from filing units.

Desirable Education and Experience

MINIMUM TRAINING AND EXPERIENCE

High School graduate with two years of office or clerical experience.