Patient Access Representative III - Edward Hospital Behavioral Health - Evening Shift

Nevada System of Higher Education

1d•$20 - $29•Onsite

About The Position

Responsible for assisting patients in the financial entry into treatment. Registering, reviewing and correcting patient registration information in the computer system. Verifying insurance coverage and eligibility on all hospital inpatient and outpatient accounts. Gathering necessary proof of insurance coverage, working closely with other departments regarding the certification process and exchanges and/or relays patient insurance information. Meeting with all uninsured patients to discuss options and obtaining payment when necessary. Ensuring the acceptance of transferring patients in a timely manner. Assisting the ARC Clinical staff with precertification, preparation and completion of the admission paperwork.

Requirements

High School Diploma or GED
A valid driver’s license is required if the incumbent is selected to perform related duties at an offsite location. If the incumbent uses their personal vehicle, the incumbent must maintain automobile liability coverage as required by law and evidence of such coverage may be requested.
Current CPR Certification issued by the American Heart Association within 90 days of start into job
CPI (Crisis Prevention Intervention) certification within 90 days of hire

Nice To Haves

Bachelor’s Degree in a mental health field
Minimum of two years of experience in crisis/emergency services, behavioral health setting
Knowledge of DSM IV-R diagnostic criteria and patient rights and law pertaining to mental health
Substantial knowledge base of insurance plans such as Commercial, Managed Care and capitated plans, Medicare, Medicaid and Workers Compensation

Responsibilities

Collaborates with a licensed clinician through the review of clinical and legal documentation to facilitate the acceptance of transfers and completes the admission paperwork.
Performs patient registration.
Reviews various forms (i.e. Release of Information, Agreement and Authorization, etc) with patients.
Ensures mandatory forms for Joint Commission and CMS are signed and reviewed with patients.
Changes room assignments, beds, programs for patients upon request.
Ensures midnight census report is obtained from each unit and adjusts appropriately in system.
Schedules patient appointments.
Transfers patients from wait list to program as capacity allows.
Contacts insurance company on each inpatient and outpatient admission to verify insurance eligibility and coverage and obtain detailed benefits for all levels of care for psychiatric and/or substance abuse.
Ensures that patient status as self-pay is confirmed through provided on-line portals
Provides patient and treatment team with quote of benefits documented in the EMR as well as completing information given to the patient
Conducts financial counseling by meeting with patient either before admission or during their stay regarding their benefits.
Counsels patient on their benefits, usage and estimated patient portions.
Collects the estimated patient portion when necessary.
Discusses applicable financial assistance options with the patient including payment plans, financial assistance application process, state or federal insurance coverage options (such as Medicaid, disability, CICP, CHP+, MCD), affordable care act plans, prompt pay discounting, and any other payment options available through Edward-Elmhurst Health.
Meets with the patient to explain their options and collects payment as necessary when an account is no longer being authorized by the insurance company.
Responds to telephone inquiries received from patients and insurance companies.
Researches and resolves accounts as requested by management.
Presents clinical to the physician on call if insurance requests peer to peer review.
Reviews clinical documentation analyzes patient status and presents the clinical data to the insurance company obtaining the initial precertification.
Problem solves any pre-cert issues with the insurance company.
Follows up with the Utilization Review department as necessary.
Conducts medical necessity reviews for all the Medicare patients.