Business Service CoordinatorBy: Shontee Fagan

EDUCATION: Winston-Salem State University Bachelor of Science in Business Administration with a concentration in Marketing, May 2007Masters in Public Administration-currently pursuingRelevant Skills and ExperienceDetail oriented Judgment and Decision Making Analytical Skills Critical Thinking Communication skills Monitoring Accounts Receivable Specialist –I investigate denials through system resources and provider insurance websites in order to have accurate information to bill private or government insurance. Analytical skills are demonstrated by ability to find trends and abnormalities in my environmentEligibility Case Worker-determine eligibility for Medicaid programs as well as to inform the client of their rights and obligations as prescribed under program policies and explain and interpret rules, policies, and procedures. The policies and procedures were set forth by Department of Health and Human Services. Important skills included negotiating, interviewing, explaining information, gathering and compiling of data, analysis of data. My duties also included managing, reviewing and coordinating case files and adhering to confidentiality policies set forth by agency compliance.

Importance of Policies and Procedures

Policies and Procedures (P&Ps) providedirection, guidance and oversight for HealthCenter operations. Public Safety and Security - Knowledge of relevant equipment, policies, procedures, and strategies to promote effective local, state, or national security operations for the protection of people, data, property, and institutions

Benefits of effective Policies and Procedures

• The formulation of effective internal controls to assure compliance with federal regulations, private payer polices and internal guidelines.

• Improved collaboration, communication and cooperation among healthcare providers and those processing and using health information

• The ability to more quickly and accurately react to employees operation compliance concerns and the capability to effectively target resources to address those concerns

• A more efficient communication system that establishes a clear process and structure for addressing compliance concerns quickly and effectively

• Procedures that allow the prompt thorough investigation of possible misconduct by corporate officers, managers, employees and independent contractor, who can impact billing decisions

• Early detection and reporting and enhancement of the structure of the billing company’s operations and the consistency between separate business units.

Billing Compliance-Policies and Procedures that govern healthcare • Employees have a obligation to maintain and protect confidentiality of company and patient information and documents. • Federal and state prohibitions against false and fraudulent claims• Record Retention and destruction• Payor Contracts• Adjustments, writeoffs or credits• Payment Information Policy• Insurance Information Policy• Processes for obtaining billing

information• HIPPA Policy

-Reviews, assesses, studies, analyzes the overall coding, billing, documentation and reimbursement system for potential compliance problems and non-compliant activities.

-Uses a systematic approach for the identification and resolution of complex compliance problems-Maintain and analyze reports to comply with various rules and regulations.-Conducts informal audits on various aspects of the coding, billing, documentation and reimbursementsystem.

Medical Billing Process

POLICIES and PROCEDURES OBJECTIVES/ELEMENTS

• Written Policies and Procedures

• Designation of a Compliance Officer or Business Service Coordinator-billing operations

• Conducting Effective Training and Education

• Developing effective lines of communication

• Enforcing standards through well-publicized disciplinary guidelines

• Auditing and Monitoring• Responding to detected

offenses and developing corrective action initiatives

Goals to have maintaining an effective billing compliance

• Appropriate oversight• Organized and effective training• Documented billing policies and

procedures• Continuous monitoring to prevent and

detect non-compliance• Providing an avenue to investigate

employee compliance concerns

Examples or situations• Campus Health Events• Possible medication or

procedure error• Quality of care issue

raised by patient• Quality of care issue

raised by staff member• Laboratory issue• Dissatisfied or angry

patient

• Injury to patients/visitors (Fainting, fall, unsafe situation)

• Patient care concern (medication error, incorrect test/procedure, triage disposition, delayed or incorrect diagnosis)

• Laboratory safety issue