Medical Biller - Physician Services

LCMC Health

13d•Onsite

About The Position

The Patient Access Representative will initiate authorization and benefits for patients. They will obtain and verify accurate identification and demographic data for the patient's permanent medical record which assists in accurate reimbursement while recognizing the necessity of maintaining the confidentiality of all patient information. The Patient Access Representative is responsible for obtaining authorization and benefits and interacting with the patients via telephone, and/or using the interpretative service when needed. The Patient Access Representative improves patient satisfaction through consistently representing LCMC professionally and cross-training to support multiple functions across all patient and payer types. They will interact with patients, doctors, pharmacies, nurses, and other clinic or hospital personnel both internal and external. The Patient Access Representative demonstrates actions consistent with LCMC's "Expectations" as duties are performed on a daily basis.

Requirements

A high school diploma or GED required
Minimum two years of experience in a healthcare environment, particularly in healthcare billing, collections, payment processing, or denial management is preferred
Strong clerical experience considered
Must be able to pass basic computer skills test and system level training
Working knowledge of system reports and the ability to analyze system information to determine the impact of possible changes
Demonstrates knowledge of: Hospital and professional billing processes and reimbursement
Third-party contracting
Insurance protocols, delay tactics, systems, and workflows
ERISA guidelines for denials and appeals
Regulations related to denials and appeals
Ability to take initiative by identifying problems, conceptualizing resolutions, and implementing change
Possesses efficient time-management skills and proven ability to multitask under tight deadlines
Demonstrates excellent customer service skills
Effective writing and communication skills
Strong comfort level with computer systems

Nice To Haves

Certification in billing and/or coding is preferred

Responsibilities

Greets patients, guests and family members both on phone or in person.
Schedules patients for services with appropriate provider at appropriate locations and desired time when possible, ensuring accuracy and timeliness.
Analyzes current patient information to determine if an account already exists so as not to duplicate records
Creates an account for all patients who present for services, including walk-in, non-scheduled, and emergency services according to the registration policy.
Registers patients by entering accurate demographic, financial class, insurance information; makes revisions to systems immediately as errors are recognized.
Activates scheduled accounts that have been set-up for the patient according to the registration policy.
Initiates bed placement, reservation, transfer, and/or discharge based on requests from clinical providers, case management, etc.
Assists patients with understanding their financial obligations, setting up payment arrangements, completing financial assistance applications, coordinating care with the providers, securing grants/resources with external sources (Drug Therapy Reimbursement) and when necessary, makes appropriate referrals to Parish Medicaid, Medicaid, or Emergency Medicaid.
Completes the patient registration and admissions process and ensures all required forms are completed and other paperwork / documents are gathered and accurate:
Requests and documents patient demographic, insurance, guarantor, MSP, and PCP/Referring Physician information and validates against current system
Ensures patient/guarantor sign all applicable documentation, such as consents and financial assistance loan application
Scans ID, insurance cards, orders, authorization information, etc. to patient’s account once the information is validated for accuracy
Performs insurance verification tasks, including: running automated eligibility response at point-of-service to ensure active coverage and completing notification of admission with insurance company within established timeframe
Contacts case management and/or provider to assist with appropriate department placement for clinical services
Analyzes physician’s order for proper bed placement functions per policy when necessary
Performs financial analysis of each case and informs patient of financial responsibility:
Informs patient/guarantor of liability due, including prior balances and estimates for scheduled service
Attempts to collect payment
Refers to financial counseling as needed
Maximizes point-of-service collection, meeting established registration collection goals
Promotes a customer centered experience by performing all functions in a warm and courteous manner to patients, family members, providers, and all visitors of the organization.
Answers incoming calls and transfers calls to appropriate areas of department/clinic/hospital.
Provides directions to applicable areas of interest, such as the department where service will be provided, financial counselor, cafeteria, waiting rooms, restrooms, and parking area.
Schedules and reschedules appointments for patients as needed, identifying open time slots and educating patient/guardian about available options for services