Health Access Rep

Capital Health•Pennington, NJ

58d•$19

About The Position

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. The listed minimum pay reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Position Overview Demonstrates service excellence by professionally assisting patients and customers with the utmost respect in a friendly caring manner. Follows all payor requirements, and identifies needs for referrals and precertification. Performs verification of benefits on all patient encounters. Audits chart for accurancy. Follows computer system, internet based insurance applications, and department operational procedures and training guidelines to obtain accurate demographic, diagnosis, authorizations/referrals and insurance information on each registration. Works collaboratively with other departments, physicians, physician office staff to obtain essential registration information such as insurance authorization, referrals, diagnosis's, and scripts, to secure financial reimbursement and customer/patient satisfaction. Complies with department procedures and regulatory guidelines for Medicare Secondary Payer, Medicare Necessity Regulations, Collection of co-pay/deposit, Advance Beneficiary Notice, Advance Directives, and Patients Rights. Registers established goal of minimum required patients per employee shift as measured by productivity reports. Correctly identifies a patient according to policy, completes all patient registration types by collecting and entering accurate patient demographics, physician information, insurance information and valid category codes. Ascertains and records appropriately the difference between patients primary care, referring physician and attending physician. Obtains all necessary signatures. Assures insurance information is verified and authorization is obtained if not done prior to service, essential registration forms are scanned into Alpha, and chart follow up is performed as needed. Ascertains and records appropriately the difference between primary care physician, referring physician and attending physician. Expert in participating CH insurance plans and the ability to identify non participating plans. Follows payer requirements for authorization, pre-authorization, referrals, coordination of benefits forms, and in-network verification according to department procedures and the Insurance Card Database and Insurance Verification guidelines. Performs verification of benefits either electronically or by telephone according to department procedures and guidelines. Identifies and obtains required precertification, authorizations and/or referrals and audits all information in the appropriate registration and billing system. Follows Financial Screening and Self Pay Procedure with regards to referrals for Medicaid and Charity Care. Makes appropriate referrals to Medicaid, Medicare and Charity for patients determined to be under insured or uninsured. Completes PE Medicaid and FD80 forms for maternity patients Attends all mandatory department meetings. Supports department performance improvement initiatives.

Requirements

High school diploma or GED.
Six months in a Health Access Rep role at Capital Health required.
One year experience in a healthcare setting or one year customer service experience with medical terminology and basic computer skills required.
Excellent communication, interpersonal and organizational skills.
Ability to problem solve and multitask and manage frequent interruption.
Expert and current knowledge of all aspects of insurance requirements.
Proficient computer skills.
Familiar with medical terminology.
Ability to handle a stressful environment.

Nice To Haves

A quality of knowledge of insurance plans and insurance experience preferred.

Responsibilities

Professionally assisting patients and customers with the utmost respect in a friendly caring manner.
Following all payor requirements, and identifies needs for referrals and precertification.
Performing verification of benefits on all patient encounters and audits chart for accurancy.
Following computer system, internet based insurance applications, and department operational procedures and training guidelines to obtain accurate demographic, diagnosis, authorizations/referrals and insurance information on each registration.
Working collaboratively with other departments, physicians, physician office staff to obtain essential registration information such as insurance authorization, referrals, diagnosis's, and scripts, to secure financial reimbursement and customer/patient satisfaction.
Complying with department procedures and regulatory guidelines for Medicare Secondary Payer, Medicare Necessity Regulations, Collection of co-pay/deposit, Advance Beneficiary Notice, Advance Directives, and Patients Rights.
Registering established goal of minimum required patients per employee shift as measured by productivity reports.
Correctly identifying a patient according to policy, completes all patient registration types by collecting and entering accurate patient demographics, physician information, insurance information and valid category codes.
Ascertaining and recording appropriately the difference between patients primary care, referring physician and attending physician.
Obtaining all necessary signatures.
Assuring insurance information is verified and authorization is obtained if not done prior to service, essential registration forms are scanned into Alpha, and chart follow up is performed as needed.
Expert in participating CH insurance plans and the ability to identify non participating plans.
Following payer requirements for authorization, pre-authorization, referrals, coordination of benefits forms, and in-network verification according to department procedures and the Insurance Card Database and Insurance Verification guidelines.
Performing verification of benefits either electronically or by telephone according to department procedures and guidelines.
Identifying and obtaining required precertification, authorizations and/or referrals and audits all information in the appropriate registration and billing system.
Following Financial Screening and Self Pay Procedure with regards to referrals for Medicaid and Charity Care.
Making appropriate referrals to Medicaid, Medicare and Charity for patients determined to be under insured or uninsured.
Completing PE Medicaid and FD80 forms for maternity patients
Attending all mandatory department meetings.
Supporting department performance improvement initiatives.

Benefits

comprehensive and highly competitive benefits package, with a variety of physical health, retirement and savings, caregiving, emotional wellbeing, transportation, robust PTO plan, overtime to eligible roles, and other benefits, including "elective" benefits employees may select to best fit the needs and personal situations of our diverse workforce.

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