Patient Access Rep III - Behavioral Health - Evanston Hospital

Patient Access Rep III

Hourly Pay Range: $19.89 - $28.84 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.

Position Highlights:

• Location: Evanston Hospital
• Full Time - 40 hours/Week
• Hours: 8:00-4:30 Monday-Friday

A Brief Overview:

Responsible for assisting patients in the financial entry into treatment. Registering, reviewing and correcting patient registration information in the computer system. Verifying insurance coverage and eligibility on all hospital inpatient and outpatient accounts. Gathering necessary proof of insurance coverage, working closely with other departments regarding the certification process and exchanges and/or relays patient insurance information. Meeting with all uninsured patients to discuss options and obtaining payment when necessary. Ensuring the acceptance of transferring patients in a timely manner. Assisting the ARC Clinical staff with precertification, preparation and completion of the admission paperwork.

What You Will Do:

• Collaborates with a licensed clinician through the review of clinical and legal documentation to facilitate the acceptance of transfers and completes the admission paperwork.
• Patient Registration Functions:
  • Performs patient registration.
  • Reviews various forms (i.e. Release of Information, Agreement and Authorization, etc) with patients.
  • Ensures mandatory forms for Joint Commission and CMS are signed and reviewed with patients.
  • Changes room assignments, beds, programs for patients upon request.
  • Ensures midnight census report is obtained from each unit and adjusts appropriately in system.
  • Schedules patient appointments.
  • Transfers patients from wait list to program as capacity allows.
• Patient Accounting Duties:
  • Contacts insurance company on each inpatient and outpatient admission to verify insurance eligibility and coverage and obtain detailed benefits for all levels of care for psychiatric and/or substance abuse.
  • Ensures that patient status as self-pay is confirmed through provided on-line portals
  • Provides patient and treatment team with quote of benefits documented in the EMR as well as completing information given to the patient
  • Conducts financial counseling by meeting with patient either before admission or during their stay regarding their benefits. Counsels patient on their benefits, usage and estimated patient portions. Collects the estimated patient portion when necessary.
  • Discusses applicable financial assistance options with the patient including payment plans, financial assistance application process, state or federal insurance coverage options (such as Medicaid, disability, CICP, CHP+, MCD), affordable care act plans, prompt pay discounting, and any other payment options available through Edward-Elmhurst Health.
  • Meets with the patient to explain their options and collects payment as necessary when an account is no longer being authorized by the insurance company.
  • Responds to telephone inquiries received from patients and insurance companies.
  • Researches and resolves accounts as requested by management.
• Assisting Intake Admission Team as needed:
  • Presents clinical to the physician on call if insurance requests peer to peer review. Reviews clinical documentation analyzes patient status and presents the clinical data to the insurance company obtaining the initial precertification. Problem solves any pre-cert issues with the insurance company. Follows up with the Utilization Review department as necessary.
  • Conducts medical necessity reviews for all the Medicare patients.

What You Will Need:

Required Education, Skills and/or Experience:

• High School Diploma or GED

Preferred Education, Skills and/or Experience:

• Bachelor's Degree in a mental health field
• Minimum of two years of experience in crisis/emergency services, behavioral health setting
• Knowledge of DSM IV-R diagnostic criteria and patient rights and law pertaining to mental health
• Substantial knowledge base of insurance plans such as Commercial, Managed Care and capitated plans, Medicare, Medicaid and Workers Compensation

Required license and/or certification:

• A valid driver's license is required if the incumbent is selected to perform related duties at an offsite location. If the incumbent uses their personal vehicle, the incumbent must maintain automobile liability coverage as required by law and evidence of such coverage may be requested.
• Current CPR Certification issued by the American Heart Association within 90 days of start into job
• CPI (Crisis Prevention Intervention) certification within 90 days of hire

Benefits (For full time or part time positions):

• Premium pay such as shift, on call, holiday and more based on an employee's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance
• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, Pet and Vision options
• Tuition Reimbursement
• Free Parking
• Wellness Program Savings Plan
• Health Savings Account Options
• Retirement Options with Company Match
• Paid Time Off and Holiday Pay
• Community Involvement Opportunities