Patient Access Rep II

Job Title

Insurance Verification Representative

Job Description

Summary of Essential Functions

• Knowledgeable of the insurance information required to properly process insurance claims and ensure prompt payment.
• Knowledgeable of hospital policies and procedures, Joint Commission standards and HIPPA Privacy Practices as related to the Admissions department.
• Fully versed in all aspects of the Insurance Verification, collections and duties.

Educational Requirements

• The formal education normally associated with complete satisfactory performance in this job is a high school diploma or equivalent (One year college course work preferred with an emphasis in business preferred). A minimum of two years of related experience in either a business setting or customer service setting is required.
• Must be able to communicate effectively in English, both verbally and in writing.
• CHAA Certification within 1 year

Qualifications/Knowledge/Skills/Abilities:

• Ability to listen and display professionalism and confidentiality
• Customer service experience and strong communication skills required
• Must be diplomatic and persistent to achieve positive results while dealing with diverse population (physicians, inter/intradepartmental health care professionals, as well as patients, families and/or significant others and community resource contacts.) Ability to communicate effectively and courteously
• Must have the ability to organize, prioritize work according to written or verbal instructions using organizational skills and sound judgment
• Admitting, insurance, collections and medical terminology are desired.
• Previous admitting/registration experience is desired.
• Past collection and insurance experience is desired.
• Requires the use of office equipment, such as computer terminals, telephones, copiers, fax machines, credit card payment processing, and ability to work in multiple computer programs simultaneously.
• Flexible hours/scheduled according to needs of the department.
• Ability to work under pressure and multi-task in a fast paced and at times stressful environment.
• Must be able to evaluate insurance eligibility responses and use critical thinking skills to appropriately act upon information regarding coverage needs, payment options or to seek out additional resources.

Physical Requirements

• Requires eye-hand coordination and manual dexterity.
• Requires corrected vision and hearing to normal range.
• Must distinguish the difference between numbers and symbols.
• On occasion may require some lifting up to 20 pounds.

Duties and Responsibilities

• Coordinates work duties in instances of sick calls or high volumes for the Insurance Verification team.
• Develops and maintains educational resources for staff reference books or training materials.
• Is the point of contact for account issues related to insurance verification or patient price estimates.
• Serves as the project lead for the implementation of projects and assignments within Insurance Verification.
• Ensures that highest possible customer service is delivered to both internal and external customers. Proactively approaches dissatisfied customers and implements customer service recovery measures. Utilizes all applicable scripting to ensure consistency within the patient experience.
• Consistently document actions taken or received on each account by inputting in the hospital system
• Makes every effort to minimize the loss of reimbursement for lack of notification, lack of authorization or denied days due to lack of continuing authorization or insurance verification. Documents all follow up done in the AMPFM system notes.
• Conducts a thorough search of patient name against the Eclipsys Master Patient Index (EMPI) in order to eliminate the risk of duplicating or making errors in selecting the correct patient or establishing a new Medical Record Number (MRN). Follows policy and procedures that govern the naming conventions, search practices and notification of changes to the MPI core data elements. Utilizes all systems available to verify information provided by patients/families.
• Evaluates insurance verification responses to ensure coverage for services by utilizing electronic systems. Utilizes critical thinking skills to evaluate patient needs based on eligibility responses. Inputs third party payer information, according to what plan is considered primary payer, secondary payer, etc. Establishes the correct assignment of payer based on coordination of benefits.
• Meets expectations regarding performance for departmental and individual metrics for registration accuracy, point of service collections, patient experience, registration productivity, account write offs, denials and rejections. The target must be achieved in order to meet performance expectations.
• Works with Utilization Review department and physician's offices to ensure that clinical requirements are obtained. Enters all benefits and pre-cert information in the account notes as instructed. Provides efficient documentation of time and person whom talked to when obtaining benefits and pre-certification data when applicable.
• Based on benefit information obtained from the patient's insurance company, creates an accurate good faith estimate letter. Utilizes all available resources to obtain CPT & Procedure Codes i.e. CPT/Procedure Code books, websites, Medical Records Coding Help Line ect.
• Quotes patient's co-share responsibility (co-payments, deductibles, & out of pocket amounts) to patient, negotiates payment options that lead towards compliance and minimizes collection expenses. Provides assistance applications according to hospital policy and regulatory requirements.
• Will follow established procedure to ensure that all Medicare regulatory requirements are met such as Medicare Secondary Payer Questionnaire (MSPQ) are collected and accurately entered into the registration system.
• Will insure that Medicare A and/or Medicare B, along with any other applicable coverage, are shown in the correct position(s) on the Insurance Plan Screen in Eclipsys, and if not, to make the appropriate corrections.
• Completes special assignments completely and in a timely manner, is quick to assist, demonstrates ability to work under deadlines and pressure. Works with Management in a positive manner when reporting trouble accounts.
• Performs all other tasks/responsibilities as necessary.

Job Info

• Job Identification 12104
• Job Category REPRESENTATIVE
• Locations Wichita Falls, TX, United States