Business Office Manager - Elizabeth Seton Children’s

Responsible for all processes of outpatient registration, insurance verification, and authorizations for medical and rehabilitative services.  Supervise Registrar and front desk personnel.

Position Functions and Responsibilities

Daily review and submission of encounters/claims to insurance carriers; while addressing any issues that may arise.

Import Medicaid files, enter all explanation of benefit information and payments from carriers and other payors timely

Monitor and resolve all claim rejections for re-submission

Obtain and/or provide medical records, therapy notes and insurance authorizations to be provided to insurance carriers when requested.

Review accuracy of all incoming payments and explanation of benefits from Insurance carriers and self-pay payments. Identify further collection and/or submission to secondary carrier as required; accept assignment when no other payor is available.  Provide documentation to the clerks for posting, and to Controller for monthly reconciliation.

Review accounts for credits and process refunds if needed.

Daily reconciliation of encounters to appointment schedule.

Daily statistical reporting and monthly unitization reports provided to Management and Controller

Provide monthly aging report to the Director of Finance and Manager of Patient Accounts review all outstanding collection issues

Reviews medical orders and authorizations to verify that billing is consistent with order; if not consult with provider

Scan and deposit checks as needed, ensuring that checks are deposited before month end

Train billing staff for coverage and to ensure future succession planning

Create and periodically update Billing Department manual to include all aspects of the department duties and instructions of how billing is done via the system

Chart carrier payments made directly to patients, and on a monthly basis send invoices to guarantor for collection of outstanding portion of receivable.

Communicate with responsible party if change of insurance occurs and/or when authorization renewals are needed

Comply with established Organizational policies and procedures

Participate in all departmental in-services, meetings, and staff development activities