Albany Medical Center

Scheduler

• Assist all patients that report to the front check in desk
• Greet patients in a prompt, courteous and professional manner
• Interact with a diverse patient population
• Utilize the electronic medical record to maintain patient records via registration process and scan functionality
• Update insurance information, attend appointment, collect patient co-pays, and other duties as assigned at the time of patient check in for scheduled appointments
• Be knowledgeable with state and government agencies to provide proper consents for patients who are wards of the state; work with facilities to obtain proper consents from patient proxies
• Schedule follow up appointments and referral as needed when patients check out
• Communicate professionally and timely with all parties, including providers, patients, clinical care team, and insurance company

Medical Scheduler – Urology Surgery

Analyst

• Under the direction of the CDM & CGT Maintenance Manager, this position is responsible for coordinating the charge master system and function, which is a listing of hospital services and procedures and the charges associated with those procedures.
• This position will utilize chargemaster management software and other resources to maintain a complete, accurate and standardized charge master.
• This position will provide charge master expertise, support, education, guidance, and recommendations to clinical and administrative departments to optimize net revenue.
• Assists in ensuring that the charge master and fee schedules are in accordance with government compliance policies and procedures, as well as third party payer needs.
• Review, identify, and analyze necessary CPT changes related to quarterly and annual AMA CPT updates and regulatory changes by timelines set.
• Works with revenue producing departments to ensure the ongoing coordinated consistency of the chargemaster and fee schedules, including accurate descriptions, coding, additions, deletions, pricing, and any other changes.
• Work with analysts to perform applicable analyses to understand net revenue effect of proposed charge master and fee schedule changes.
• Conduct annual review of the charge master and quarterly updates as appropriate to enhance revenue for the hospital departments.
• Serves as resource to Patient Financial Services staff for reporting problems and denials on individual claims.
• Assists in researching coding issues and recommends solution to account representative.
• Identifies source of problem and works with analysts to implement corrective actions to ensure that the chargemaster is updated to prevent future rejections/denials and to ensure accurate and expedient reimbursement.
• Assist in strategic pricing process to optimize reimbursement within budget guidelines.
• Participate in ongoing coordination and resolution of revenue issues as they arise.
• Assists in troubleshooting and resolving issues related to the patient revenue cycle and assists in development and recommendations.
• Assist in the develop and maintain policies and procedures for the CDM, Pricing Policies and charge capture processes.
• Builds and nurtures collaborative supporting relationships with the AMHS executive team, clinical chairs, faculty, clinicians, and other leaders across the health system and encourages, promotes, and advocates staff to ensure integration of new processes across all departments.
• Acts as source of reference for enterprise on regulatory, reimbursement or billing changes, and develops and implements training to maintain and support compliance with federal and state regulations.
• Maintains a working knowledge of revenue cycle process to aid in the implementation of regulatory standards that assist compliant charge capture practices.
• Monitors compliance with corporate, federal, and state guidelines to include review of commercial bulletins for HCPCS/CPT code changes and additions and billing unit rule changes.

Charge Master Analyst – Revenue Cycle

General

• Obtain and accurately record patient’s vital signs; reports abnormal values to treating provider
• Obtains and documents a patient’s history (Medical, Surgical and Social) and focused physical assessment, related to the clinic visit and as dictated by clinic procedure
• Administers medications and treatments to patients in clinic, under the direction of a physician or APP
• Participates in in-office procedure, as related to clinic specialty, under the direction and supervision of a Physician or APP and documents results in EHR
• Performs review and triage of incoming test results, patient requests and pharmacy renewals; facilitates call-backs to patients as necessary
• Facilitates the utilization of resources to meet patient outcomes and contribute to Facility (AMC), New York State and National Quality data metrics
• Delegates tasks deemed appropriate per licensure of LPN and/or MA
• Adheres to AMC’s regulatory agency (The Joint Commission) and internal compliance policies
• Orientation and education of newly hired staff
• Completes continuous/annual education related to Clinic specialty to maintain knowledge base on current practices
• Provides education to patients related to their visit and overall health and wellness

RN – Ambulatory Pediatric Specialties

Manager

• Provides overall administrative management of a variety of business-related functions, strategic planning, budget development and cost center management under the direction of the Practice Administrator
• Provides hands-on leadership for all aspects of patient relations, staffing, marketing, insurance, and financial activities to ensure their successful management
• Works closely with the Practice Administrator, Nurse Supervisor, Department Chair, and the Division Heads to establish and maintain an efficient, cohesive and productive work team within the entire department and to help the practice achieve the institutional mission of high quality provision of care for patients
• Directly supervises all administrative staff, and clinical staff (in absence of Nurse)
• Acts as an information resource for administrative questions in close cooperation with Administrator
• Maintains effective communication with staff in all levels in a timely and effective manner
• Monitors all time performance and pay practices and systems for effectiveness and cost containment
• Regularly review and make recommendations to Administrator for updated employee job descriptions and (re)allocation of job duties
• Ensure all policies and procedures of the institution are followed operationally
• Monitor and notify credentialed staff when licenses/credentials are up for renewal
• Develop and maintain employee’s annual goals, and coach, mentor and encourage employee achievement of those goals
• Prepare annual performance review for any direct reports; review and collaborate other APR’s as requested by management
• Develop staff incentive programs to maintain and/or increase staff morale and reduce turnover
• Handle any employee issues or grievances
• Manage payroll and benefits for staff
• Prepare bi-weekly payroll
• Complete all new hire and termination processes timely via Workday
• Monitor and intercede with any issues regarding the staff schedule for all departments and sites and authorizes and denies overtime when necessary
• Coordinate, facilitate and document staff meetings and ensure institutional and departmental information and initiatives are shared consistently and effectively
• Monitors staff for compliance
• Acts as a resource to Practice Coordinators within the Faculty Practice, by providing mentorship and guidance to foster their growth and development
• Assists Administrator as requested during budget preparation and manages the overall operating budget for the Department
• Investigates discrepancies and significant changes in monthly income and expenses; reports discrepancies to the Administrator
• Monitors staff performance through consistent measurement. Recommends opportunity for improvement, initiates training and/or corrective actions, focused on the importance of maximizing results
• Ensures proper invoicing and tracking of receivables and payments to vendors
• Responsible for Accounts Payable and accurate record keeping of expenses
• Maintain excellent communication on billing matters between the department and billing departments
• Assess the needs in collaboration with staff for annual expenses. Evaluates and negotiates with vendors in conjunction with the Administrator to procure capital equipment, processes purchase orders and coordinates installation and operation
• Audit performance of sites for compliance with standards, policies and procedures
• Ensure completion of regular tracking reports and tasks through completion, management or delegation, reporting anomalies to Administrator timely
• Ensure compliance with all The Joint Commission non-clinical and any other governing regulatory authority
• Serves as a resource for facilities management for the practice including any repairs, service contracts for equipment and the inventory of all capital equipment and audits for completion
• Maintains optimal physical environment for the Department and reports any unsafe conditions, inoperative equipment or other adverse conditions to Administrator
• Assists Practice Administrator in development and evaluation of departmental policies and procedures
• Assists Practice Administrator in Practice-wide special projects
• Prepares staff to respond effectively to both internal and external company issues
• Uses discretion at all times to ensure patient confidentiality
• Provide administrative support to Faculty, APP’s, and Administrator

Practice Manager

• Responsible for scheduling appointments and services for assigned service line (POD) via the scheduling system following established scripting and protocols promoting physician satisfaction and scheduling efficiencies on behalf of our patients
• Ability to identify trigger words, symptoms and patient concerns, assuring calls are triaged to the respective Clinic Nursing team per protocol
• Responsible for discerning demographic and insurance information to ensure accurate registration
• Responsible to interpret information received from Insurance Payer regarding patient’s eligibility and financial responsibility
• Responsible for discussing financial obligation of patient and collect via cash, credit card or check
• Ability to accurately interpret referral/physician order to meet the patient and/or provider need for scheduling of services correctly
• Responsible for scanning or managing online form template to maintain the Electronic Health Record
• Comprehend Federal, State, Third Party Payer regulations as it pertains to a hospital and practice pre-registration
• Ability to work in multiple systems during a telephone call or patient facing interaction to complete an accurate registration and support clinical workflow
• Responsible for review of services being rendered to ensure the appropriate setting of care has been assigned by the physician’s office
• Obtains all insurance information from patient and verifies insurance to ensure active coverage for services being scheduling
• Provides thorough comments, where applicable for all conversations with patients or providers

Pre-Service Specialist I

• Assists colleagues in collaborative care for Pediatric Specialties
• Performs assigned tasks of direct and indirect care in the ambulatory setting
• Participates as a member of the health care team
• Documents information into patient records accurately and timely
• Obtains prior authorizations from insurance companies
• Generates medical renewals under the supervision of a licensed healthcare provider
• Assists LPNs with obtaining information for approvals
• Adheres to AMC’s regulatory compliance issues
• Other responsibilities as assigned by manager

Medical Assistant – Outpatient Pediatric Specialties

• Obtain and accurately record patient’s vital signs; reports abnormal values to treating provider
• Obtains and documents a patient’s history (Medical, Surgical and Social) and focused physical assessment, related to the clinic visit and as dictated by clinic procedure
• Administers medications and treatments to patients in clinic, under the direction of a physician or APP
• Participates in in-office procedure, as related to clinic specialty, under the direction and supervision of a Physician or APP and documents results in EHR
• Performs review and triage of incoming test results, patient requests and pharmacy renewals; facilitates call-backs to patients as necessary
• Facilitates the utilization of resources to meet patient outcomes and contribute to Facility (AMC), New York State and National Quality data metrics
• Delegates tasks deemed appropriate per licensure of LPN and/or MA
• Adheres to AMC’s regulatory agency and internal compliance policies
• Orientation and education of newly hired staff
• Completes continuous/annual education related to Clinic specialty to maintain knowledge base on current practices
• Provides education to patients related to their visit and overall health and wellness

RN – Ambulatory

Medical Billing and Coding

• Resolve all billing edits found in the assigned WQs.
• Respond to denials received on accounts as assigned. This may require a re-billing of a claim after updating the correct information or it may require the initiation of a dispute or appeal to the payer.
• Collaborate professionally internally or with external departments when needed to resolve the edit or denial.
• Recognize payer trends amongst the claims that are editing for similar reasons.
• Communicate those trends to leaders within the department to determine if a systematic update is required.
• Identify payer trends within the denials and work with leaders to mitigate those denials where possible.
• Goal to minimize aging AR.
• Proper and detailed notation of actions taken on the account. Others will rely on those notes when taking the next step on the account follow up.
• Payer Website navigation as needed to obtain information.
• Review, understand, and locate payer policy guidelines for billing or denial resolution.
• Proficient use of Epic, On Base, and other platforms as needed.
• Ability to work independently and under time constraints and deadlines and with minimal supervision.
• to prioritize workload in an effective manner.
• Meet daily/weekly productivity standards with acceptable QA results.
• Other duties as assigned.

Medical Billing Associate

• Resolve all levels of denials.
• Professional appeal submission with supporting documentation.
• Identify and present the payer trends amongst the claims that are denying.
• Communicate and work with the leaders to mitigate.
• Collaborate professionally internally or with external departments when needed to resolve the edit or denial.
• Present appropriate accounts for payer agendas with clear rationale and supporting documentation.
• Ability to be the learning partner for peers.
• Manage and complete assigned projects timely.
• Proper and detailed notation of actions taken on the account.
• Review, understand, and locate payer policy guidelines as required.
• Ability to locate claim adjudication details with the supporting documentation.
• Proficient use of Epic, OnBase, and other platforms as needed.
• Meet daily/weekly productivity standards with acceptable QA results.

Medical Billing Specialist

• Medical Billing Associate handles billing and follow up of medical claims
• Focus on pre-billing edits and introductory payer denials
• Initiate appeals or rebill claims to address denials
• Work independently to meet production standards
• Communicate with peers, trainers, and leaders
• Resolve billing edits and respond to denials on accounts as assigned
• Collaborate with internal/external departments as needed
• Recognize payer trends and communicate them to leaders