Holland Hospital

Business Operations

• Works under the direction of the Practice/Program Manager overseeing day-to-day operations.
• Coordinates, implements and evaluates current practices to promote high-quality, cost-effective care.
• Ensures focus on enhancing patient and staff satisfaction.
• Participates in staffing plan and hiring tasks.
• Manages staff and physicians schedules.
• Prepares for accreditation and audits.

Business Operations Coordinator

Billing Specialist

• Provide exemplary customer service.
• Work daily electronic billing system (Cerner & nThrive) and submits insurance claims to third-party payers.
• Review daily claim edits from the hospital billing system and makes necessary corrections.
• Assess claim edits daily leading to resolution within 24-48 hours.
• Maintain a thorough understanding of federal and state regulations as well as requirements specific to Medicare, Medicaid, and fiscal intermediaries.
• Communicate edits that may need joint resolution with external departments.
• Prepare and submit manual insurance claims to third-party payers who do not accept electronic claims or who require special handling.
• Resubmit claims that may need corrections.
• Verify claims have been received by appropriate payer.
• Investigate and resolve issues in regards to claim transmission.
• Mail/Fax/Email paper claims to the appropriate payer the day they are generated.
• Perform effective follow-up on all outstanding debit and credit balances within the expected time period.
• Review and analyze outstanding debit and credit balances to determine appropriate follow-up.
• Contribute innovatively to the success of the department and ensure compliance in patient and billing aspects.
• Maintain a base-line understanding of federal and state regulations, as well as specific payer requirements.
• Effectively handle communications from payers and departments within and outside of the department.
• Understand and maintain compliance with HIPAA guidelines when handling patient information.
• Document all activity taken within an encounter in the billing system.
• Clear and concise messaging.
• Responsible for making and documenting timely phone calls to insurance regarding billing matters.
• Provide updates to existing policies and procedures as needed and propose new.
• Communicate with staff routinely and effectively using all forms of communication.

Business Operations Coordinator

Insurance Billing Specialist, Full Time, Days