NHRMC, established in 1967 in Wilmington, NC, is recognized as a preeminent healthcare organization focused on leading our community to outstanding health. We have an 855 bed network of hospitals and multi-specialty physician group practices with more than 200 physicians. With a network of primary, specialty, neighborhood clinics and regional medical centers; you will find our culture is the very definition of best in practice. Join us and find out how many ways NHRMC offers you the chance to focus on what really matters - our patients and community.
About the Job
Location: New Hanover Medical Group
Department: NHMG Administration
Full Time Equivalent: FTE: 1.000000
Work Type: 64 to 80 Hours Pay Period
Work Schedule: STD HRS - Standard-Exe or Office w flex
Exempt from Overtime: Exempt: No
What You'll Do
The Business Office Representative is responsible for the primary functions of the Practice Business office. Responsibilities include, claims reviews, billing inquiries and insurance issues and/or patient concerns. The Sr Business Office Representative is expected to participate in the education of the staff and must have the ability to make decisions and solve problems.
Responsibility II: Billing
• Ensures physician charges are applied to the correct patient account by verifying information indicated on charge document against system information.
• Perform limited ICD-9 and CPT-4 coding from charge slips, encounter forms, or source documentation.
• Research credit balances and request refunds appropriately.
• Communicates with manager any emerging denials, trends, etc.
Responsibility III: Claims
• Ensures billing and filing of insurance by Central Billing Office (Professional billing) and System Billing Office (Technical or Facility billing) is completed accurately and in accordance with requirements of third party intermediaries
• Follow-up with insurance companies and inquire on claim status of any unpaid claim aged 45 days guidelines
• Recognizes EOB denial, payment and pending remark codes
• Maintain a working knowledge of insurance appeals processes and be proficient in writing an appeal letter
Responsibility IV: Insurance
• Utilize telephone and internet to verify insurance benefits for new patients and patients scheduled for comprehensive examinations for all locations. Provide insurance verification forms to reception staff prior to patient appointments.
• Accurately update patient demographic information as provided by patients and/or insurance companies
Responsibility V: General Practice Duties
• Plays a key role in on-boarding and training of new staff as needed and is willing to cross train to cover additional needs of the practice
• Participates in short range planning, professional development of staff, goal setting development and completion of action plans. Works with Manager and Director in development of strategic plans.
• Coordinates workflow patterns and serves as a senior resource for issues and concerns presented by patients/customers. Deescalates situations and problem solves proactively without intervention from leadership.
• Knowledge of Fair Debt Collection Practices Act, PHI, HIPAA as well as other State and Federal regulations pertaining to health insurance statutes
• Ability and flexibility to cover various medical offices when needed
• Performs cash management protocols as assigned
• Adheres to company policy on continuing education programs, i.e. Annual HIPAA training
• Adheres to departmental dress codes as observed by director and wears picture identification badge, 100% of the time.
* High School Diploma
Experience: At least 3 year previous medical office experience working within a patient registration, insurance verification, claims analyzing or billing role. Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence.
Performs other duties as assigned.
Individual will possess commensurate combination of education, experience and qualifications.
This position description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications which may be required of the employee assigned to the position. Depending on the location of the job, duties may vary. Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind; my employment with the Company is at will.
- Member Top 100 Hospitals – In 2016 NHRMC was recognized as a Top 100 Hospital demonstrating significant investment and financial sustainability for the communities we serve.
- Newsweek's 2020 list of Best Maternity Care Hospitals - NHRMC Betty H. Cameron Women's & Children's Hospital was named as a Best Maternity Care Hospital by Newsweek.
- Forbes America’s Best Large Employers 2018 and 2019- Link
- Becker’s 150 Top Places to Work in Healthcare- Link
- Healthgrades Outstanding Patient Experience
Consider a career at NHRMC and become part of this award winning team!