What are the responsibilities and job description for the Business Office Representative position at The Consortium Inc.?
Job Details
Summary Primary responsibilities include managing all information related to services provided to individuals as it pertains to access, administration and billing. All information will be maintained in the Agency’s information systems. Position serves as the on-site lead for processes and issues related to billing information.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Greets and interviews individuals who are seeking services.
- Accurately and completely registers all individuals in the agency’s computer system; and processes all data/forms related to registration per agency policies and procedures on a daily basis.
- Verifies insurance coverage with insurance carriers for each individual on the agreed cycle of verification determined by the program needs and obtains precertification or authorization for treatment as needed. In situations where insurability is questionable or uncertain, works with current and prospective individuals as well as agency experts to obtain and document insurance eligibility whenever and wherever possible.
Periodically reviews individual records to reassess insurability; assists individuals in obtaining insurance as necessary to avoid provision of services that are unbillable.
Assists with billing and coding and clears unbilled and rejected claims by working cooperatively with clinical personnel and the billing department.
Ensures that demographic information is kept up to date in the system; Regularly asks individuals about changes in their demographic information and insurance provider and/or coverage. Makes changes or corrections as needed and notifies the billing department of such changes.
Utilizes multiple notification methods to immediately inform appropriate people (individual served, Business Office Manager and Program Supervisor) of insurance or other issues that may impede billing or payment for services rendered.
Initiates troubleshooting of insurance issues that may affect the payment for services rendered.
Works with program leadership to resolve issues as necessary. Follows-up until problems are resolved Informs uninsured individuals of the Agency’s policies and practices for providing services.
Refers individuals to the Business Office Manager and Program Management for final determination.
Directs individuals to resources within or outside of the Agency to help them obtain appropriate insurance coverages. Updates systems when insurance coverage is provided and documented.
Accurately schedules initial intake appointments in a manner that maximizes daily service delivery.
Uses internal reports to identify, troubleshoot and resolve unbilled services and rejection problems on a timely basis. Works cooperatively with others to accomplish the objective. Refers certain issues to Business Office Manager and/or billing function for direction or resolution as appropriate.
Prepares intake documentation to create initial medical record/chart.
Collects, documents and tracks payments as stipulated by individual’s health insurance coverage. Provides supervisor with an accurate accounting of all monies collected and turned in on a daily basis.
Prepares and sends routine individual information and billing related correspondence as authorized by supervisor or clinical staff in accordance with agency policies on confidentiality and HIPPA requirements.
May prepare responses to requests for confidential information from external sources
Answers telephone professionally and courteously according to agency Standards (by the third ring). Promptly returns customer calls according to agency Standards (within 30 minutes- external customers; 24 hours internal customers).
Responsible for timely processing and response to emails in accordance with Agency standards. Prepares physical documentation of all participant related information and changes thereto; manages the review and sign off process by program leadership and others as appropriate.
Maintains all administrative and billing data and information throughout the life cycle of an individual’s tenure with the agency, including but not limited to: authorizations for service that are current at all times, status of insurance eligibility assessments, and other information required for complete, accurate and timely billing of services for assigned participants.
Performs other duties as necessary and directed by the Business Office Manager.
Disclaimer:
This information has been designed to indicate the general nature and level of work performed by employees in this role. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications.
The Consortium is an EOE/Veterans/Disabled/LGBT employer.
The Consortium is proud to be an equal opportunity workplace. We will consider all qualified applicants for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, genetic information, or any other basis protected by applicable law.
Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Understanding and competence with regard to information management and Billing systems Understanding and competence with regard to all processes relevant to establishing and maintaining individual information
Ability to effectively identify problems, troubleshoot and resolve issues.
Knowledge of business English, spelling and punctuation, office practice and procedures Able to type 40-45 wpm
Proficiency in use of Microsoft Office (Word, Excel)
Strong people skills, able to successfully work in a team and a self-starter
Education and/or Experience
Associates degree preferred or equivalent from two-year college or technical school and or six months to one year related experience and/or training; or equivalent combination of education and experience.
