Entry Level Ethics Compliance Jobs (NOW HIRING)

Job Description

JOB SUMMARY

Responsible for verification and data entry of patient demographics, insurance eligibility, and benefit verification. Calculates, communicates, and collects patient financial responsibility before, during, or after services are provided, as appropriate.  Negotiates, processes, and follows up on payment plan agreements.  Files insurance claims and works rejected or errored claims. Assists the CMP clinics as appropriate. This is an entry level physician billing position.

Job Specific 

1. Verify patient demographics and proper completion of all required patient registration forms, including accurate data entry into practice management system. (EF)

2. Verify medical insurance eligibility and benefit coverage, including accurate data entry into the practice management system. (EF)

3. Determine or calculate patient financial responsibility using all available tools (e.g., insurance patient estimators, internal calculation spreadsheets, insurance fee schedules, etc.). (EF)

4. Screen clinic schedules for high balances and bad debt utilizing all available tools (e.g., Phreesia, practice management system, etc.) and attempt to collect prior to the scheduled appointment. (EF)

5. Collect, process, post, and deposit patient payments, including working the prepay bucket in the practice management system.  (EF)

6. Set-up and process payment plan agreements and financial assistance applications, including delinquent payment follow-up. (EF)

7. File professional claims daily.  Reviews and corrects any claim rejections and edits, or forwards to the appropriate team member for correction, and resubmits rejected claims after correction. (EF)

8. Review, print, and/or process patient statements in accordance with established timelines. (EF)

9. Organize, process, and complete the deposit protocol daily, including data entry into the general ledger. (EF)

10. Sort, transport, and deliver mail and interdepartmental mail throughout the hospital campus. (EF)

11. Document all patient, insurance, or other communication in accordance with departmental policy. (EF)

Teamwork & Communication

12 . Assist the CMP clinics with check-in and check-out functions. (EF)

13. Assist the CMP clinics with patient demographics, insurance eligibility, insurance benefit verification, and data entry. (EF)

14. Provide excellent and professional customer service, at all times, to patients, staff, managers, and clinicians.

15. Consult team members, supervisor, director, and other appropriate resources to resolve billing and collection questions and issues. (EF)

16. Maintain a collaborative working relationship with clinic staff, managers, clinicians, and the coding department.

17. Plan and participate in departmental meetings with clinic staff, managers, administrators, advanced practices providers, and physicians. (EF)

Education

18. Once obtained, maintain professional certifications as required by the certifying organization. (EF)

19. Remain current with most recent revisions of billing and collections standards and federal regulations to comply with all legal requirements regarding billing and collection practices.  (EF)

20. Actively participate in all required in-service education.  

Hospital:

1. Adheres to organization-wide and other applicable policies and procedures.
2. Day-to-day performance complies with the hospital’s Service Excellence Behavioral Expectations.
3. Performs within the prescribed limits of the hospital’s Ethics, Compliance and Confidentiality Program guidelines.
4. Performs within professional Scope of Practice at all times.

Other Duties As Assigned:

• Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Job Requirements

EDUCATIONAL REQUIREMENTS

Required:  High School diploma or equivalent

Preferred: 

• Knowledge of health insurance (HMO, PPO, Medicare, Medicaid, etc.)
• Knowledge of insurance benefits terms (copay, deductible, coinsurance, etc.)
• Referral and authorization requirements
• Knowledge of medical anatomy and terminology
• Associates degree in a healthcare related field

EXPERIENCE

Preferred: One year of current medical billing experience in a physician office/practice setting within the last three years.

SPECIAL SKILLS AND ABILITIES

Required: Able to work in a collaborative team environment; good mathematical, verbal and written communication skills; able to organize and complete work in a timely manner; basic proficiency in Microsoft Office365 apps; basic proficiency using telephone, fax, and email.

Preferred: Able to read, interpret, and communicate all parts of an explanation of benefits or electronic remittance advice; intermediate proficiency in Microsoft Office365 apps.

LICENSURE / CERTIFICATION REQUIREMENTS

Preferred: Certified Medical Reimbursement Specialist (CMRS) certification or an approved, equivalent certification.

COMPANY PROFILE

Citizens Medical Center is a not-for-profit, community hospital known for compassionate patient care, clinical expertise, and bringing advanced medical services to the South Texas region since 1956. Today, Citizens is a 317-bed acute care hospital with over 1,200 employees. Voted “Best of the Best” hospital in Victoria for 14 consecutive years, Citizens Medical Center is a level III Trauma Center, currently renovating its 24/7 Emergency Department that includes an onsite medical helicopter. Citizens has a comprehensive Community Cancer Program that includes two linear accelerators and HDR brachytherapy. Citizens is recognized for its outstanding cardiology program which includes a nationally accredited Chest Pain Center and is a Primary Stroke Center. Citizens also includes a comprehensive, accredited Bariatric Surgery program, Birth Center with labor and delivery, an imaging and surgery center, sleep study center, state-of-the-art rehabilitation and fitness center, urology center and daVinci robotics minimally invasive surgery options, a home health agency, and has a long history of providing continuing education for healthcare providers and the community.

Citizens Medical Center is looking for employees who display respect and enthusiasm for patients, visitors, and coworkers, and who consistently uphold the organization’s commitment to providing outstanding outcomes and an excellent experience.

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

BENEFIT OFFERINGS

Health

• Medical, Dental, Vision
• STD, LTD Disability
• Supplemental Life, AD&D
• Flexible Spending (FSA)
• Employer paid life insurance 

Retirement/Investment

• Defined Benefit Pension Plan
• 457(b) Deferred Compensation

Well-Being Benefits

• Paid Time Off & Sick leave
• Bereavement leave, Jury Duty/Witness Service
• Hospital-paid & administered annual immunizations
• HealthPlex (gym) membership discount
• YMCA partnership discount for childcare
• Employee Assistance Programs