Patient Access Representative III - PAS Pre Cert and Authorization

Job Title

Responsible for creating the first impression of the organization's services to patients and families and other external customers. Essential duties may include performing all pre-arrival duties related to the pre-registration and financial clearance process for both outpatient and inpatient services. This position is responsible for collecting proper demographic and financial data to insure hospital bill is paid by a third party payer or the patient, in addition to verifying insurance eligibility, referral coordination, and securing authorization. Acts as primary liaison for patients receiving professional and hospital services at ECU Health.

Responsibilities

Conducts phone interview and completes pre-certification and insurance verification process prior to the patient's scheduled arrival.

Collects complete and accurate demographic, financial, and clinical information to properly enter into the electronic health record to properly a hospital registration.

Obtains diagnosis and procedure information from patient, clinical department or physician offices to perform ABN/Medical Necessity screening, as required.

Reviews registration account for accuracy to ensure the hospital is properly reimbursed.

Works closely with physician office staff and utilization review/case management to coordinate certification process (initial authorization and extended stay authorization).

Resolves any insurance verification and financial clearance issue prior to or during hospital service; this involves contacting insurance/third party payers to resolve eligibility and benefits issues and to initiate insurance appeals if necessary.

Pre-registers patient by transcribing data provided by the doctor's office.

Negotiates deposits and payment arrangements with patients and or guarantors and attempt to collect patient copayments or other uninsured balances on accounts.

Explains financial obligations, negotiates deposits and payment arrangements with patients and or guarantors and attempt to collect patient copayments or other uninsured balances on accounts.

Verify insurance benefits using the electronic insurance eligibility application (Passport), internet application or telephone calls to insurance carriers, obtain authorizations and pre-certification for applicable visits.

Cross trained to perform other functions within the division as assigned.

Serves as a coach to new staff as assigned.

Provides feedback to management on issues that impact departmental workflow.

Provide focused training for individuals identified by the Team Lead and/or Supervisor.

Ensure that scheduling and registration reports and work queues are being addressed by Insurance Verifiers.

Assist management with special projects and reports.

Serve in a lead capacity for departmental goals and initiatives.

Other duties as assigned.

Minimum Requirements

High School or Equivalent (GED) or higher is required.

Associate Degree: preferred.

Bachelors Degree: preferred.

2 to 4 years of Registration, Scheduling and Insurance Authorization experience within a healthcare setting is required.

5 years of customer service experience is required.

Excellent communication (both written and oral), detail orientation, organization, and multitasking skills required.

Proficient computer skills; Experience with Microsoft Office applications (Outlook, Word and Excel).

Preferred Experience with EPIC and medical office workflows.

Insurance Verification Experience.

Other Information

Monday - Friday 8am - 5pm.

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.