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Highmark - Pittsburgh, PA

posted about 2 months ago

Pittsburgh, PA
Insurance Carriers and Related Activities

About the position

The position involves completing various processes within Patient Access, including scheduling, pre-registration, financial clearance, authorization and referral validation, and pre-serviceability estimations and collections. The role is crucial in creating the first impression of Allegheny Health Network's services to patients and families, ensuring they understand their financial responsibilities and what to expect. The employee assumes clinical and financial risk by collecting and documenting information on behalf of the patient.

Responsibilities

  • Conducts scheduling and preregistration functions, validates patient demographic data, identifies and verifies medical benefits, accurate plan code and COB order, and obtains limited clinical data based on service required.
  • Verifies insurance information through payor contacts via telephone, online resources, or electronic verification system, identifies payor authorization/referral requirements, and provides appropriate documentation and follow-up.
  • Identifies all patient financial responsibilities, calculates estimates, collects liabilities, and performs daily reconciliation.
  • Delivers positive patient experience and maintains excellent working relationships with patients, AHN leadership and staff, physician offices, and designated external agencies or vendors.
  • Maintains focus on attaining productivity standards and recommends innovative approaches for enhancing performance and productivity.
  • Adheres to AHN organizational policies and procedures and completes mandatory training and education sessions.
  • Performs other duties as assigned or required.

Requirements

  • High school diploma or GED; or one to three months related experience and/or training; or equivalent combination of education and experience.
  • One previous year of related experience, preferably within a medical setting, financial services setting, and/or a demanding customer service environment.
  • Experience operating a PC and using software applications.

Nice-to-haves

  • Medical terminology and obtaining insurance verifications.
  • Call/Service Center experience.

Benefits

  • $1,000 Sign-on Bonus for external hires only, with conditions.
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