Key tasks and responsibilities
Responsible to have a thorough working knowledge of all managed care contracts.
Responsible to post all patient account payments in the Patient Accounting System (PAS) using the following guidelines.
Open a separate batch for each deposit (one for each day—mail & OTC (over the counter are separate). Balance and close batch when finished.
File by deposit date with bank confirmation on top; write batch number on report.
Use managed care grid, contracts and insurance websites to verify what insurance has allowed is correct.
Make sure for all contracted payers to subtract all deductibles or co-pays from the allowable first, and then multiply by patient’s policy %.
For Out-of-Network.: Use the in-network % to figure patient portion. Do not turn any deductible to patient responsibility unless it cross-applies. Use quoted amount as noted in verification notes to calculate patient coinsurance amount.
Advantx only: If payment is not correct, and they did not pay for a specific CPT code, do not post any money to that CPT—post to unapplied. Copy EOB and give to appropriate collector.
Advantx only: If insurance did not pay for implants and should have, do not post money to implant code. Copy EOB for appropriate collector for follow-up.
If insurance made partial payment on everything (figured at wrong amounts or % rates) post what was paid, leaving correct balance for collector.
If payment is correct and patient owes a balance, transfer balance to patient.
If patient has second insurance, transfer to secondary insurance. Make copy of EOB excluding EFT’s and given to assigned person.
All -0- pay EOBs with balance applied the patient’s deductible should be transferred to the patient balance.
All -0- pay EOBs with balance applied as a duplicate claim with payment already received should be reviewed and filed by date received. Exception: duplicate claim EOB when appeal is on file should be sent back to collector.
All -0- pay EOBs with balance applied as a duplicate claim without prior payment should be reviewed and given to assigned person.
If additional write offs need to be made to make balance correct, make them.
If Correction of write offs (written off incorrectly at TOB) need to be made to make balance correct, make them.
Advantx only: USE SPECIFIC JOURNAL CODES. Do not just use “correction” or “write off” or “unapplied payment”—if code not available ask Business Office Manager to add it.
To post insurance overpayment—Make sure insurance adjustments are correct, leaving the correct insurance overpayment amount. Enter an explanation for the overpayment and make sure the insurance line is marked “complete” so that it moves to a collector’s insurance overpayment workflow.
Patient overpayment – If patient paid DOS and our estimate was too high, transfer overpayment to any unpaid balances. Make sure the insurance line is marked “complete” so that the patient overpayment moves into the patient overpayment workflow to be refunded.
Balance payments posted with bank deposit. Totals should equal less any miscellaneous receipts.
Responsible to enter all deposits, A/P check runs, and bank charges in the monthly deposit log.
Responsible to reconcile patient refunds for month by ensuring what was posted in the PAS matches what was processed through Accounts Payable.
Responsible to post only adjustments and refunds that have proper authorization.
Responsible to work closely with Biller to ensure correct time-of-billing write offs.
Responsible to report payer problems or concerns to management.
Responsible to periodically review credit balances.
Responsible to review monthly credit balance reports provided by corporate accountant.
Responsible to comply with all USPI internal control practices and policies.
Follows regulations and guidelines protecting the confidentiality of health related information.
Performs others duties as assigned.
Experience preferred in Patient’s Accounting System and in working with managed care. Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent. Requires a high school certificate or equivalency.
Oklahoma City, Oklahoma, United States
Oklahoma Center for Orthopaedic & Multi-Specialty Surgery (11702)
Company Location Description