Patient Access Rep II

United Regional•Wichita Falls, TX

2d•Onsite

About The Position

This role is responsible for processing insurance claims, ensuring prompt payment, and understanding hospital policies, Joint Commission standards, and HIPPA Privacy Practices related to the Admissions department. The position requires full knowledge of insurance verification, collections, and related duties.

Requirements

High school diploma or equivalent.
A minimum of two years of related experience in either a business setting or customer service setting is required.
Must be able to communicate effectively in English, both verbally and in writing.
Ability to listen and display professionalism and confidentiality.
Customer service experience and strong communication skills required.
Must be diplomatic and persistent to achieve positive results while dealing with diverse population.
Ability to communicate effectively and courteously.
Must have the ability to organize, prioritize work according to written or verbal instructions using organizational skills and sound judgment.
Requires the use of office equipment, such as computer terminals, telephones, copiers, fax machines, credit card payment processing, and ability to work in multiple computer programs simultaneously.
Ability to work under pressure and multi-task in a fast paced and at times stressful environment.
Must be able to evaluate insurance eligibility responses and use critical thinking skills to appropriately act upon information regarding coverage needs, payment options or to seek out additional resources.

Nice To Haves

One year college coursework preferred with an emphasis in business preferred.
CHAA Certification within 1 year
Admitting, insurance, collections and medical terminology are desired.
Previous admitting/registration experience is desired.
Past collection and insurance experience is desired.

Responsibilities

Coordinates work duties in instances of sick calls or high volumes for the Insurance Verification team.
Develops and maintains educational resources for staff reference books or training materials.
Serves as the point of contact for account issues related to insurance verification or patient price estimates.
Serves as the project lead for the implementation of projects and assignments within Insurance Verification.
Ensures that the highest possible customer service is delivered to both internal and external customers.
Consistently documents actions taken or received on each account by inputting in the hospital system.
Minimizes the loss of reimbursement for lack of notification, lack of authorization or denied days due to lack of continuing authorization or insurance verification.
Conducts a thorough search of patient name against the Eclipsys Master Patient Index (EMPI) to eliminate the risk of duplicating or making errors.
Evaluates insurance verification responses to ensure coverage for services by utilizing electronic systems.
Meets expectations regarding performance for departmental and individual metrics for registration accuracy, point of service collections, patient experience, registration productivity, account write offs, denials and rejections.
Works with Utilization Review department and physician’s offices to ensure that clinical requirements are obtained.
Creates an accurate good faith estimate letter based on benefit information obtained from the patient’s insurance company.
Quotes patient’s co-share responsibility (co-payments, deductibles, & out of pocket amounts) to patient, negotiates payment options that lead towards compliance and minimizes collection expenses.
Follows established procedure to ensure that all Medicare regulatory requirements are met such as Medicare Secondary Payer Questionnaire (MSPQ) are collected and accurately entered into the registration system.
Ensures that Medicare A and/or Medicare B, along with any other applicable coverage, are shown in the correct position(s) on the Insurance Plan Screen in Eclipsys, and if not, to make the appropriate corrections.
Completes special assignments completely and in a timely manner, is quick to assist, demonstrates ability to work under deadlines and pressure.
Performs all other tasks/responsibilities as necessary.