Front Office Operations Specialist

Job Description

About the Company

Prisma Health is an organization whose values include: Inspire health. Serve with compassion. Be the difference. Its vision is simple: to transform healthcare for the benefits of the communities served. The organization believes that this transformation requires talented individuals in every role.

Job Description

This role is primarily focused on front office management and operation, handling various administrative and patient-facing responsibilities within Prisma Health. A key requirement for this position is regional travel across all Prisma Health sites.

Key Responsibilities and Functions:

• Adherence to Values: All team members are expected to be knowledgeable and compliant with Prisma Health’s values: Inspire health, serve with compassion, be the difference.
• Patient Registration & Data Management:
• Complete and accurate patient registration.
• Verifying and updating necessary insurance information in the patient accounting system (online registration).
• Obtaining signatures on all required forms and documents.
• Maintaining appointment books and adhering to office scheduling policies.
• Maintaining and updating current information on physician’s schedules.
• Registering new patients after verifying their status on the computer, and updating financial information as indicated.
• Financial & Billing Management:
• Responsible for precertification, charge capture, and accurately coding diagnoses provided by physicians.
• Posting all payments and balancing with computer reports at day end.
• Arranging for patient pre-payments and enforcing financial agreements prior to service.
• Gathering charge information, coding, entering into the database, completing, and distributing billing information.
• Filing insurance claims and assisting patients in completing insurance forms.
• Processing unpaid accounts by contacting patients and third-party payers.
• Gathering, accurately coding, and posting outpatient charges to superbills.
• Processing vouchers and private payments, including updating registration screens based on check information.
• Assisting with processing mail return statements and outgoing statements.
• Performing cashiering functions, including monitoring and balancing the cash drawer daily, preparing daily cash payments, receiving payments from patients, issuing receipts, coding and posting payments, and maintaining required financial records.
• Processing edits and Customer Service and Collection Requests for resolution within specified time frames.
• Researching all information needed to complete the outpatient billing process, including obtaining charge information from physicians.
• Keying charge information into the online entry program.
• Processing and distributing copies of billings according to clinic policies.
• Collecting payments at the time of service for daily outpatient visit services.
• Performing collection actions, including contacting patients by telephone and resubmitting claims to third-party reimbursers.
• Evaluating patient financial status and establishing budget payment plans.
• Reviewing accounts for possible assignment to a collection agency and making recommendations to the Clinical Department Practice Manager.
• Participating with other staff to follow up on accounts until a zero balance is achieved or they are turned over for collection.
• Entering all charge and same-day payment information for patient visits and hospital patients, verifying the accuracy of coding, charging, and patient insurance status.
• Backing up and closing computer files on a daily basis, logging as appropriate (e.g., closing all batches in accordance with policy).
• Patient and Visitor Interaction:
• Requires a high level of public contact and excellent interpersonal skills.
• Serving as a liaison between the patient and medical support staff.
• Greeting patients and visitors in a prompt, courteous, and helpful manner.
• Assisting patients with ambulatory difficulties.
• Overseeing the waiting area, coordinating patient movement, and reporting problems or irregularities.
• Answering patient questions and inquiries regarding their accounts.
• Scheduling & Coordination:
• Scheduling surgeries, ancillary services, follow-up outpatient appointments, and admissions.
• Phone Support:
• Providing front office phone support as needed and outlined through a cross-training program.
• Medical Records Management:
• Delivering, transporting, sorting, and filing returned charts.
• Picking up lab reports, dictations, X-rays, and correspondence.
• Filing all medical reports.
• Purging obsolete records and files in storage.
• Destroying outdated records following established procedures for retention and destruction.
• Making up new patient charts and repairing damaged charts.
• Assisting in locating and filing records.
• Working with medical assistants and other staff to route patient charts to the proper location.
• Insurance and Claims Assistance:
• Assisting patients with questions on insurance claims, obtaining disability insurance benefits, home health care, medical equipment, surgical care, etc.
• Processing benefit correspondence, signature, and insurance forms to expedite payment of outstanding claims.
• Assisting patients in completing all necessary forms to obtain hospitalization or surgical pre-certification from insurance companies.
• Following up with insurance companies to ensure coverage is approved.
• Confirming all workers’ compensation claims with employees.
• Preparing disability claims in a timely manner.
• Maintaining files with referral slips, medical authorizations, and insurance slips.
• General Administrative & Professionalism:
• Maintaining the strictest confidentiality.
• Participating in educational activities.
• Maintaining a neat and professional appearance as a representative of Prisma Health.
• Demonstrating a commitment to serve at all times and upholding guidelines set forth in the office manual.
• Performing other duties as assigned.

Supervisory/Management Responsibilities:

• This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements:

• Education: High School Diploma or equivalent; OR Post High School Diploma. An Associate degree in a technical specialty program of 18 months minimum in length is preferred.
• Experience: No previous experience is required, though multi-specialty group practice setting experience is preferred.

Knowledge, Skills, and Abilities:

• A basic understanding of ICD-9 and CPT coding is preferred.
• Requires excellent interpersonal skills and the ability to handle a high level of public contact.