Merrimack Valley Endoscopy Center - Business Office Specialist

POSITION SUMMARY:

Under the direction of the Business Office Manager or Center Administrator, the Business Office Specialist (BOS) can assume responsibility for multiple business office functions based on the needs of the Center. Functions may include any combination of insurance verification, front desk coordination, surgery scheduling, medical records coordination, credentialing, collection of financial responsibilities, administrative assistance, and other business office operations as assigned and trained by the Business Office Manager. This role requires strong communication with patients, internal colleagues, physician offices, vendors, and external partners; attention to detail; and knowledge of healthcare insurance plans, billing procedures, credentialing processes, and other primary functions associated with a medical practice. This position also serves as a platform for cross-training and professional development across all business office functions.

DUTIES/RESPONSIBILITIES

Front desk coordination:

• Answer and triage phone calls, greet and speak with patients and family members in a friendly and compassionate manner.
• Monitor the main entrance and serve as first point of contact for all visitors at the Center. Maintain daily visitor log.
• Prepare welcome packets and necessary documentation for next day cases.
• Provide welcome packets, and check-in patients including collecting and scanning of documents, verify, and input patient data.
• Print estimate forms and obtain patient signature. Collect payment as needed or set up payment plans.
• Give appropriate instructions to patients and family members at the time of admission regarding expectations of the day.
• Appropriately record information in patient’s medical record including the download of information from EHR/paper chart to EMR.
• Responsible for vendor credentialing and access of vendors to the Center.
• Maintain waiting area and the front desk area in a neat and orderly manner.

Credentialing:

• Coordinate and oversee vendor and physician credentialing activities in accordance with Center policies, accreditation requirements, and regulatory standards.
• Maintain accurate and up-to-date credentialing files and documentation for physicians, vendors, and other approved personnel.
• Track expiration dates for licenses, certifications, insurance coverage, and other required credentialing documents and ensure timely renewals.
• Facilitate onboarding and credentialing processes for new physicians and vendors.
• Serve as a liaison between the Center, vendors, physicians, credentialing organizations, and regulatory agencies as needed.
• Ensure compliance with all credentialing standards and maintain readiness for audits, surveys, and accreditation reviews.
• Monitor vendor access requirements and maintain vendor credentialing systems utilized by the Center.

Surgery scheduling:

• Receive and review surgery requests from surgeon’s offices and ensure all information is complete and entered into EMR.
• Coordinate with surgeons, patients, and the surgical team to ensure smooth scheduling and efficient use of resources.
• Resolve scheduling conflicts as they occur and manage late bookings as they occur.
• Obtain pre-authorizations, collect demographics, and relevant documents needed for booking the case.
• Record special equipment or implants as needed for surgical procedures and notify appropriate parties including pain blocks, anesthesia, and neuromonitoring.
• Manage and maintain block scheduling; review statistics associated with block utilization and provide recommendations based on trends.
• Maintain accurate and up-to-date patient records and documentation.

Insurance verification:

• Verify insurance coverage by confirming patient’s insurance eligibility and benefits with various providers (HMOs, PPOs, Medicare, and Medicaid); document and update patient insurance details in the system and maintain up-to-date records.
• Investigate and resolve discrepancies in insurance information attached to patient account.
• Ensure valid authorizations were received from physician’s office for the scheduled procedure; confirm by contacting insurance companies and contacting physician’s offices in the event of missing authorizations.
• Communicate coverage details, and financial estimates to patients prior to services rendered; obtain payments for procedures; address insurance-related inquiries.
• Collect any outstanding balances; inform revenue cycle when account has outstanding insurance balance.
• Document all necessary information to the billing department for accurate claims processing.
• Adhere to HIPAA and other relevant regulations.
• Understand and apply ICD-10, CPT, and HCPCS codes when verifying coverage.
• Remain current on all case verification; the standard operating procedure is two weeks prior to date of service.
• Notify the Business Office Manager in the event of insurance or authorization discrepancies or balances due.
• Run daily reports to ensure all cases are verified, authorized, and financial counseling is complete.

Administrative assistance:

• Answer and triage phone calls, greet and speak with patients and family members in a friendly and compassionate manner.
• Assist in monitoring the main entrance and serve as a point of contact for all visitors at the Center.
• Manage incoming and outgoing mail and faxes.
• Compose emails and other correspondence.
• Schedule meetings, manage calendars, coordinate meetings and events.
• Maintain physical and electronic files, databases, and other record-keeping systems.
• Prepare memos, reports, invoices, and other documents; proofread and edit written materials.
• Order office supplies, coordinate equipment maintenance, and manage vendor relationships.
• Book flights, hotels, and transportation for employees.
• Assist with project management tasks such as tracking deadlines and facilitating communication.
• Maintain waiting area and the front desk area in a neat and orderly manner.
• Maintain confidentiality of Center and patient information at all times to ensure compliance.

Assume ownership of additional business office functions as assigned and trained by the Business Office Manager or Center Administrator. Cross-train in other business office responsibilities to support operational needs and provide coverage as necessary. Perform other duties as assigned.

EDUCATION/EXPERIENCE

REQUIRED:

• High school diploma or equivalent
• Medical office experience
• Proficient computer skills and office administrative experience
• BLS certification (as required by individual ASC policy)

PREFERRED

• Insurance verification or billing experience in a healthcare environment
• Ambulatory surgery center business office experience