Payer Notification III

Wellstar Health System•VIRTUAL-GA, GA

5d•Onsite

About The Position

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Requirements

Minimum 1 year of healthcare experience in Patient Access Services, Practice Operations, or Patient Financial Services.
Bachelors degree or higher may substitute for experience.
CHAA - Cert Healthcare Access Assoc or CPAR - Certified Patient Account Rep or CRCR - Certified Revenue Cycle Rep or CRCR-P - Certified Revenue Cycle Rep - Provisional (90 Days) within 120 Days
Effective communication skills (both written and verbal) with the ability to communicate with various members of the healthcare team.
High attention to detail, self-directed and a positive attitude are essential.
Effective problem solving and critical thinking skills.
Typing or data entry competency of at least 40 words/minute.
Cash handling and balancing.
Demonstrated professionalism, effective communication skills and active listening skills.

Nice To Haves

Epic experience
Working knowledge of patient registration systems and intermediate Microsoft Office Suite are preferred.

Responsibilities

Secure accounts by performing a combination of insurance verification to gather benefit information if not already obtained and validating prior authorization has been initiated with the payer before services are rendered.
Work with physicians, nurses, clinic managers and financial advocates to resolve issues that arise during the prior authorizations process.
Support Pre-Registration including preparing patient estimates.
Maintain established productivity benchmarks and meets goals in a fast-paced environment.
Verify insurance eligibility, benefits, network status and creates pre-service liability estimate.
Ensure accurate ICD, CPT codes and related medical records are submitted in the authorization request.
Secure prior authorizations for scheduled and nonscheduled services.
Act as a liaison between the payer and clinic schedulers/medical support staff.
Follow up on delayed or denied authorization requests and escalates for resolution.
Create detailed documentation and maintains/stores the authorization paper/electronic trail.
Work in the work queues to resolve claims denials related to the prior authorization.
Observe work hours and provides proper notice of absences, tardiness, or work schedule changes.
Maintain courteous and cooperative working relationships with WHS management, patients, physicians, other professional contacts, and the public.
Demonstrate ability to tactfully handle difficult situations.
Present a well-groomed and professional image.
Document thorough explanatory notes on patient accounts, concerning any non-routine circumstances, clarifying special billing processes.
Maintain a working knowledge of available information system capabilities and performs all system applications that are required.
Understand and apply WHS philosophy and objectives, and PAS policies and procedures, as related to assigned duties.
Understand the admission, outpatient and emergency registration process.
Maintain confidentiality of patient information, in accordance with WHS policy and HIPPA regulations.
Consistently demonstrate the ability to organize work, recognizes and establishes appropriate work priorities, and completes work in a productive manner, without creating backlogs.
Maintain proficiency in data entry skills.
Assist physicians and their office staff to expedite scheduling, pre-admission, Medicaid screening and pre-certifications on all accounts.
Resolve errors and applicable Claim, DNB and Patient Work Queues.
Attempt to collect the estimated self-pay balance of all inpatient, outpatient and ER accounts, at the earliest possible collection control point.
Monitor in-house accounts and attempts to make financial arrangements with guarantors for payment of their self-pay balances in full and prior to discharge.
Complete financial evaluation forms to document guarantors' income, expenses, assets and liabilities.
Identify those patients without adequate insurance coverage.
Make personal contact with patient or guarantor to determine guarantor's ability to pay non-covered charges, as well as to determine potential eligibility for financial assistance programs (namely Medicaid).
Maintain a list of health care financial assistance programs and the eligibility requirements for each program.
Refer patients/guarantors to sources of outside funding assistance, as needed.
Work efficiently and accurately within designated time frames to ensure a continuity of information and cash flow.
Contact scheduled patients at home to obtain pre-admission information, explain financial policies, estimate self-pay balances, and obtain a promise to pay on or before admission/registration.
Interview all inpatients and select (self-pay) outpatients at time of registration, or at least within 24 hours of admission, to verify complete insurance and financial information, explain financial policies, and collect the estimated self-pay balance.
Document concise and understandable notes regarding all self-pay account collection activity, as well as each patient or guarantor interaction.
Document all efforts to collect patient account balances, other self-pay collection activities and referrals to Medicaid.
Coordinate financial counseling activities with Admitting, Outpatient Registration, Emergency Registration, Utilization Review, Nursing, Social Services, and Patient Financial Services.
Verify insurance coverage and benefits.
Exceed monthly quota on a consistent basis.
Formally report results of self-pay collection activity to direct supervisor, on a daily basis or according to policy.
Provide feedback to PAS management concerning self-pay collection and data integrity issues.
Responsible for completion of appropriate error/issues in WorkQueues.
Identify and resolve Payor Denials as indicated.
Greet all guest with a positive and professional attitude.
Receive patients valuables for safekeeping in the hospital safe.
Answer incoming phone calls and follow through with requests made.
Create first impressions, memorable moments and impressions that fulfill the expressed and unexpressed wishes and needs of patients and family members.
Value patients and family members as partners in their care.
Deliver high-touch care that is reliable, responsive and coordinated.
Focus on constant innovation and creating improvements.
Celebrate diversity with sensitivity and understanding.
Embrace the idea that we are all owners of our health system.
Attend select departmental meetings at the request of WHS Management.
Complete monthly, quarterly, and annual mandatory training as required.
Serve as preceptors and mentors.
Maintain a based on individual QA audit /or as reported by Epic (min. of 10 accounts) registration accuracy rate or higher in the past 12 months.
Maintain minimum productivity requirements.
Willing and able to function as a preceptor in the orientation of new patient access personnel and students.
Maintain required certifications by obtaining necessary CEUs and submitting timely to certifying board.
Comply with all WellStar Health System policies, standards of work, and code of conduct.