• Contacts and interviews patients, responsible parties and insurance companies regarding hospital or ambulatory service to secure insurance benefits.

• Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms (EDI transactions, web access and by calling payers) and documenting information within the appropriate registration system, supporting with reference number.

• Determines the need for appropriate service authorizations (pre-certifications, 3rd party authorizations, referrals) and contacts the payer, physician and/or case management/utilization review personnel, as necessary. Ensure authorization matches test(s) ordered

• Pre-registers the patient for upcoming visit(s) including validating/obtaining and entering demographic, financial, and insurance information.

• Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance.

• Contacts physicians/office staff for clarification, if cases require clarification of diagnosis and/or test(s)/procedure(s).

• Informs patient/guarantor of their liabilities and collects appropriate patient co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration.

• Calculates patient liabilities and provides financial education, referring the patient to resource counseling, as required. Documents payments/actions in the patient accounting system and provides the patient with a payment receipt. Assists patient with payment arrangements as needed for remaining balance.

• Properly screens appropriate patients for market insurance.

• Obtains signed physician orders for scheduled tests and procedures from physicians/offices for testing and procedures, and scans into electronic record.

• Completes appropriate follow-up on insurance denials and initiates appeal, retro-authorization, etc. as needed.

• Assists insurance companies, physician, and physician practices, and or hospital departments with patient information in accordance with HIPAA guidelines.

• Meets or exceeds accuracy standard goal determined by Patient Access Leadership; Ensures integrity of patient accounts by working error reports daily, entering accurate data, and documenting all attempts made to collect and or obtain missing documentation.

• Other duties as assigned

Minimum Qualifications

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:

Education and Formal Training: 

• High school graduate or equivalent required

• Associates Degree in Business or Health Care Administration and/or Computer Technology preferred

• Patient Access Specialist certification (CPAS) required within 1 year of employment

Work Experience: 

• 1 year insurance/clerical experience within a hospital or medical office setting

Knowledge, Skills, and Abilities Required: 

• Proficiency in reading, writing, and speaking the English language

• Knowledge of insurance and collection of payments

• Knowledge of Medical Terminology

• Knowledge of Microsoft software

• Excellent verbal and written communication skills, customer service skills and problem-solving abilities

• Ability to appropriately handle complexity and stress with the changing needs of the patients, families, visitors, and the Health System.

• May be required to periodically rotate shifts and regular days off

• All system employees must have the flexibility to meet the department hours of operation

Physical Requirements: 

• Must be able to communicate orally, see, and hear to collect information

• Must have dexterity to operate office equipment.

• Position operates in an office, call center environment

• The incumbent is subject to eyestrain due to the many hours spent looking at a CRT screen.

• The noise level is low to moderate.

• Bends, reaches, pushes and pulls file drawers to file records and reports.

• Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds.