Patient Access Representative III

Common Spirit•Houston, TX

44d

About The Position

Assist in providing access to services provided at the hospital. Knowledge of all tasks performed in the various Verification/Preâcertification area is necessary to provide optimum internal and external customer satisfaction and provide the opportunity for accurate reimbursement. The position basic function is for the verification of eligibility/benefits information for the patient's visit, obtaining Preâcer/Authorization/Notifying Third Party payers within compliance of contractual agreements with a high degree of accuracy. Participates in upfront collections by informing the patient of the estimated patient portion during insurance verification. Responsible for establishing the hospital's financial expectation for the patient and/or guarantor and ensuring accurate information is exchanged which determines whether the account will be processed in an efficient and expedient manner for the hospital and the patient.

Requirements

High School Diploma/GED
Two (2) years of related experience
Extended knowledge of HMO's , PPO's, Commercial/Governmental payers and System/Entity specific hospital contracts with Third Party payers.
Extended knowledge of HIPPA and EMTALA.

Nice To Haves

Scheduling and Oncology experience
Knowledge of Epic systems and use of decision trees.

Responsibilities

Obtains detailed patient insurance benefit information.
Discusses benefits and other financial issues with patients and/or family members during initial evaluation.
Advises patients on insurance and billing issues and options. Serves as a resource for patients and their family members on financial matters.
Coordinates all necessary payer authorizations.
Consistently monitors and updates information regarding insurance data, physicians, authorizations and managed care contracting.
Assists patients and their families with questions concerning insurance and other financial issues.
Identifies and effectively communicates financial information team members, patients and their families with emphasis on identifying any potential patient outâofâpocket liability.
Works with patients, their families and team members when possible to help address insurance coverage gaps via alternative funding options.
Facilitates resolution of patient billing issues
Ensures payers are listed Accurately, pertaining to primary, secondary, and/or tertiary coverage and billing when a patient has multiple third party/governmental payers listed on an account.
Process patient accounts and deploy established policies to resolve insurance issues with patient accounts.
Initiate preâcert for inâhouse patients when required, obtaining preâcertification reference number, approved length of stay, and utilization review company contact person and telephone number.
Notify hospital Case Managers on all inâhouse patients regarding insurance plan changes/COB order, out of network plans, and Medicare supplemental plans that require preâcertification.
Contact physician's on scheduled patients, to notify them of authorization requirements and any possible financial holds.
Analyze reports to ensure admission dates for patient type changes are accurate in order for the account to appear on insurance verification reports.
Maintain and update reference notebooks on insurance companies, employers, preâcertification requirements, etc to stay current on changes within the insurance industry.
May function as team lead to ensure smooth operation of daily activities. This may include assisting with coverage, scheduling, providing feedback, and quality assurance.
Call Center environment.