Pediatric Surgery Patient Care Coordinator

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Position Overview

This role is integral to the management and operation of the front office within the Pediatric Surgery department. The individual will handle various front office responsibilities as outlined below.

Key Responsibilities

• Ensure thorough and precise patient registration, pre-authorization, charge capture, and accurate coding of diagnoses as provided by physicians. Responsible for payment posting and reconciliation with daily computer reports. This role requires exceptional public interaction and strong interpersonal skills. Facilitate patient pre-payments and uphold financial agreements prior to service delivery. Collect charge information, code, input into the database, complete billing processes, and distribute billing statements. Submit insurance claims and assist patients in filling out insurance documentation. Manage unpaid accounts by reaching out to patients and third-party payers. - 20%
• Act as a liaison between patients and medical support personnel. Welcome patients and visitors in a timely, courteous, and helpful manner. Check in patients, verify and update necessary insurance details in the patient accounting system. Secure signatures on all required forms and documents. Assist patients with mobility challenges. Maintain the appointment schedule and adhere to office scheduling protocols. Provide front office phone support as needed through cross-training. Screen visitors and respond to routine inquiries. Responsible for gathering, coding, and posting outpatient charges. Process vouchers and private payments, updating registration screens based on check information. Research address verification as necessary. Assist in processing returned mail statements and outgoing statements. Collect billing information for all physicians for patients seen in practice. Perform cashiering duties, including monitoring and balancing the cash drawer daily. Prepare daily cash deposits. Accept payments from patients and issue receipts. Code and post payments while maintaining required records, reports, and files. Collaborate with patients to secure prepayment sources or financial agreements before service delivery. Work with colleagues to achieve account resolution. Assist with outpatient coding and error correction. Process edits and customer service requests for resolution within specified timeframes. Identify trends and communicate issues to management. Update patient account databases. Maintain current information on physician schedules. Schedule surgeries, ancillary services, and follow-up outpatient appointments as requested. Address inquiries regarding patient appointments and testing. Prepare patient charts for the next day’s visits. Update profiles for all patients, ensuring completeness and accuracy. Oversee the waiting area, coordinate patient flow, and report any issues or irregularities. - 20%
• Assist patients with inquiries regarding insurance claims, disability benefits, home health care, medical equipment, surgical services, etc. Process benefit correspondence, signatures, and insurance forms to expedite the payment of outstanding claims. Help patients complete necessary forms for hospitalization or surgical pre-authorization from insurance providers. Follow up with insurance companies to ensure coverage approval. Document all actions and maintain permanent records of patient accounts. Address patient questions and concerns regarding their accounts. Confirm all workers' compensation claims with employees. Prepare disability claims promptly. Follow up with insurance companies to ensure claims are paid as directed. Maintain files with referral slips, medical authorizations, and insurance documentation. - 20%
• Research all necessary information to complete the outpatient billing process, including obtaining charge information from physicians. Code information about procedures performed and diagnoses on charges. Input charge information into the online entry system. Process and distribute billing copies according to clinic policies. Assist with outpatient coding and error resolution. Retrieve charts for scheduled appointments in advance. Deliver, transport, sort, and file returned charts. Collect lab reports, dictations, X-rays, and correspondence. Regularly check for misfiled charts and refile according to the established system. Maintain organized files. File all medical reports. Purge obsolete records and files in storage. Destroy outdated records following established retention and destruction procedures. Create new patient charts. Repair damaged charts. Assist in locating and filing records. Collaborate with medical assistants and other staff to route patient charts to the appropriate locations. Adhere to medical records policies and procedures. - 20%
• Collect payments at the time of service for outpatient visits. Review each account via computer to ensure timely payment. Conduct collection actions, including contacting patients by phone and resubmitting claims to third-party payers. Assess patient financial status and establish budget payment plans. Review accounts for potential assignment to collection agencies and make recommendations to the Clinical Department Practice Manager. Identify and resolve patient billing complaints. Collaborate with colleagues to follow up on accounts until they reach a zero balance or are referred for collection. Participate in educational activities. Gather and verify superbills for specified practices daily. Enter all charge and same-day payment information for patient visits and hospital patients, ensuring accuracy in coding, charging, and patient insurance status. Print daily reports to verify charge entry balancing at day’s end. Back up and close computer files daily, logging as appropriate (i.e., closing all batches in accordance with policy). Register new patients after verifying their status in the computer system. Update financial information as necessary. Maintain strict confidentiality. Engage in educational activities. Perform related duties as required. As a representative of Prisma Health Clinical Department, maintain a neat and professional appearance, demonstrate a commitment to service at all times, and uphold guidelines set forth in the office manual. - 20%

Supervisory/Management Responsibility

This is a non-management position reporting to a supervisor, manager, director, or executive.

Minimum Qualifications

High School diploma or equivalent OR Post-high school diploma. An associate degree in a technical specialty program of at least 18 months in length is preferred.

No prior experience is required. Experience in a multi-specialty group practice setting is preferred.

In Lieu Of

• N/A

Required Certifications, Registrations, Licenses

• N/A

Knowledge, Skills, and Abilities

• Basic understanding of ICD-9 and CPT coding is preferred.

Work Shift

Day (United States of America)

Location

Facility 3465 Pediatric Surgery

Department

Pediatric Surgery Practice Operations

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