Job Description

Key Responsibilities: 
* Review all accounts to verify eligibility and benefits, determine coordination of benefits, and assure appropriate authorization (i.e., pre-certification, referral) is in place s needed.
* Review and troubleshoot all accounts to determine accuracy and patient eligibility for state/federal insurance programs.
* Determine method of payment for elective cosmetic procedures. Collect patient payments prior to service where applicable.
* Monitor and execute all "UR" changes in the computer system.  Act on changes in a timely manner.  Provide the necessary notification to HIS, BAR, physician, insurance companies and nursing floors.
* Organize and prioritize work to meet insurance plan authorization deadlines.
* Correct patient registration and account information in a timely manner to ensure accurate billing and reimbursement.
* Investigate and pursue any and all sources (i.e. physician, nursing home, employers, relative etc.) of information to determine insurance or other liability coverage.
* Utilize all available payer systems and vehicles i.e., web-site, fax and telephone, for eligibility and authorization processing.
* Review all observation and inpatient accounts, and serve as a reminder to the UR Case Manager of length of stay requirements. Coordinate the transfer of information to QA/UR in a timely manner.
* Provide notification of non-covered services to patient/physicians' office (i.e. Medicare outpatient dental, cosmetic, nutrition).
* Coordinate with physicians' offices the submission of the notification of service to the insurance company.
* Enter BAR notes to reflect all insurance verification activities and outcomes. Review patient registration and account details for effective insurance verification processing.
* Follow-up on denied accounts by assisting in the appeals process.
* Refer self pay or under-insured patient to the appropriate Medical Assistance  Financial  Counselors in a timely manner.
* Is able to perform basic registration functions.
* Make recommendations to improve Patient Access Service systems and processes.
* Maintain working knowledge of payor web-site applications used to conduct eligibility and authorization processing.
* Create a friendly caring environment by being considerate to coworkers and outside consultants/out reach worker.
* Be compassionate to patient's concern regarding their insurance coverage and questions that they might have.
* Respond to questions in a timely manner
* Adheres to Medical Center dress code promoting a good image of themselves, their department and the Medical Center


Required Knowledge & Skills:
Reception/office or other healthcare experience required. Medical setting and medical terminology preferred. Previous computer entry / word processing experience required. Meditech knowledge helpful. Strong communication and interpersonal skills required.


Education: 
High School diploma or equivalent.
Software/Hardware:
Previous computer entry / word processing experience required. Meditech knowledge helpful. Strong communication and interpersonal skills required.

 

Application Instructions

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