Surgical Information Systems

Insurance

• Willing to learn software billing systems
• Generates Patient Statements, uploading to statement vendor daily
• Places Courtesy Calls to patients regarding outstanding balance(s)
• Initiates contact through online solutions; like Text Messaging, dialer, etc…
• Creates and Reports to client(s) Monthly Collections List for accounts that require review and approval to send to Collection Agency and/or written off to bad debt
• Researches and explains patient financial responsibility, according to Explanation of Benefits and Facilities Self Pay policy guidelines
• Handles all inbound calls from patients and clients regarding Self Pay Accounts Receivable
• Researches and Documents all patient contact (inbound or outbound) in clients software system, which includes clear and detailed description of action taken, next step and expected resolution date
• Monitors and resolves all Self Pay Accounts Receivable upon Self Pay entry or transfer date from Insurance; Follow up at least once every 30 days with more frequent follow up as necessary
• Credit card payments processed to center in a timely fashion
• Collaborates cross-functionally within the team, to accomplish adjustment requests, insurance research, etc…
• Other duties as assigned

Self Pay/Insurance Verification Specialist

• Obtain demographics/insurance information from Ambulatory Surgical Centers/Doctors office
• Patient registration (enter information into system)
• Verify insurance with appropriate payor(s)
• Enter all insurance information into system
• Enter patient notes if applicable
• If applicable, call patient and advise of financial responsibility
• Provide admitting clerk with up-front money to be collected
• Collect payments from patients at time of service or at notification of amount due
• Scanning

Insurance Verification Specialist

QA Engineer

• Lead quality reviews of billing activities to ensure accuracy, compliance, and adherence to established workflows and client-specific requirements.
• Support the Revenue Cycle Services team by identifying errors, documenting findings, and contributing to continuous improvement efforts.
• Perform routine quality audits on billing activities, including charge entry, claim creation, claim submission, and corrections.
• Validate accuracy of CPT/HCPCS codes, modifiers, and diagnosis codes.
• Ensure compliance with client-specific billing guidelines, payer rules, and internal SOPs.
• Document audit results clearly, including error categorization and supporting detail.
• Enter audit findings into QA tracking tools and dashboards.
• Escalate recurring or high-risk issues to the QA Manager.
• Track error trends and contribute insights to help reduce downstream denials and rework.
• Prepare and present audit feedback with billing team leads and supervisors.

Lead Billing QA

Manager

• Reviewing and analyzing medical billing and coding for processing while assisting with client management and managing the coding team.
• Adheres to the ICD-9/ICD-10 coding conventions, official coding guidelines approved by CPT, AMA, AAOS, and CCI.
• Consults physicians for clarification and additional documentation prior to code assignment when there is conflicting or ambiguous data in the health record.
• Strives for the optimal payment to which the facility is legally entitled.
• Assists and educates physicians and other clinicians by advocating proper documentation practices.
• Adheres to OIG guidelines.
• Ensures the coding site specifics are updated as needed for each center assigned.
• Identifies and tracks all cases that are not able to be billed due to lacking information.
• Responsible for properly performing month end tasks within the established timeframe including running month end reports for each center assigned and tracking of cases that are not yet billed for the month.
• Client management, including emails, phone calls, and video meetings with client staff as well as physicians.
• Aid clients in denial management and coding reviews.
• Manage a coding team consisting of Team Leads and production coders.
• Productivity management of cases coded.
• Approve employee time and payroll entries.
• Provide training and ongoing education to coders.

Manager, Coding

Consultant

• Assist clients with application configuration, based on user needs and industry standards
• Learn and Perform project management tasks to take clients through project life cycle
• Train administrative and end users on the application.
• Work with Managers to determine business and clinical requirements and establish partnership with client for successful implementation for the project team (client, vendors, and SIS).
• Review, discuss, understand, and execute the processes and procedures with the team on all facets of the project; including project kickoff, milestones, training and education, reporting, interfacing, troubleshooting, and issue tracking, and escalation.
• Learn to identify client-associated risks and provide actions or solutions.
• Give a hands-on approach to the implementation process.
• Help to identify possible risks with the client on a continual basis during the project life cycle.
• Review, assess, and help manage the application scope of work and scheduling.
• Exposure to and use of ASC billing practices
• Assist and focus client in directing resources and efforts to achieve project goals.
• Address client’s application issues and close all issues before transition to Support.

Onboarding Consultant

Customer Support

• Post payments.
• Work credit balances.
• Transfer balances to self-pay or secondary insurance.
• Send accounts to charge posters for secondary insurance submission.
• Give accounts to Insurance Collector for follow-up.
• Place appropriate notes in patient accounts.
• Send denials to code review.
• Scanning.
• Other duties as assigned

Payment Support Specialist

• Lead a revenue cycle team/region offering direct supervision to assigned managers
• Communicate proactively towards decisions and actions that will assure success for clients
• Partner closely with other RCMs, Sr. Managers, clients, and others to determine and support staffing, tools, coaching, and training needs
• Drive commitment to accomplishing consistent, quality daily results
• Coach team members to develop work plans focusing on time management, organization, and metrics
• Review client cash summary and posting folder in SharePoint
• Manage month-end duties and confirm all month-end reports are run
• Review billing for clients and resolve billing queries
• Manage Waystar rejections and fix COB errors
• Validate quantity and quality of AR follow-up metrics

Revenue Cycle Manager

• Maintain site specifics for assigned clients
• Be able to verify the correct contract rate is applied to the billing
• Work billing rejections in clearinghouses: Waystar
• Communicate and supply documentation to coding and billing department including Op notes, implant logs, pathology reports
• Be the go between providing document management between coding team, billing team and client to effectively bill claim
• Provide feedback, guidance, and training support to billers to correct and prevent charge posting errors
• Monitor quality of charge entry and claim submission
• Ensure timely filing of claims via electronic submission or paper submission
• Resolve and reconcile submissions, rejections and edits daily
• Must have a clear understanding of the insurance collection process
• Ability to solve problems associated with tasks
• Enter charge corrections provided by AR Specialists and rebill to payers as needed
• Correct and resend rejected claims
• Generate EOM unbilled reporting
• Familiar with CPT codes, ICD and modifiers
• Calculate pricing for implants and supplies accurately based on site specifics
• Communicate professionally with internal and/or external clients
• Pull case documents for audits as needed
• Posting for Clients with offshore restrictions as needed
• Perform other assigned duties