Rehabilitation Access Representative
About The Position
Assesses insurance requirements for all new and established outpatients as it relates to their specified therapies. Works with clinicians and outpatients to provide an understanding of insurance requirements, evaluates patient insurance benefits, and obtains authorizations in a timely manner. Educates patients in their specific insurance benefits and limitations. Assists patients in navigation of insurance plan, including use of insurance helper tools to ensure patients are aware of deductibles, co-pay amounts, co-insurance amounts, diagnostic exclusions, allowable visits, and need for authorization for therapies. Maintains meticulous documentation and tracking of all communications with insurance companies and works closely with Patient Access and Patient Accounts departments to maximize successful practices and reimbursements. Answers patients and families questions regarding their insurance and provides estimates of co-pay amounts. Facilitates interdisciplinary communication in a timely manner and serves as a resource to all Rehabilitation disciplines. Functions as a super user to ensure department compliance with system and operational changes and assists in training to support ongoing staff education and development.
Requirements
- High School diploma or equivalent.
- Previous experience in healthcare required.
- Strong organizational skills and ability to create organizational systems.
- Excellent verbal and written communication skills.
- Knowledge of medical terminology.
- Strong knowledge of Medicare health plans, Medicaid guidelines, insurance plans and co-pay assistance programs, and charitable programs.
- Ability to assess and interpret a patient's insurance benefits.
- Ability to work independently and be self motivated.
Nice To Haves
- Previous Medical Secretary, Unit Secretary, or Rehab Assistant/Aide experience preferred.
- Health Access experience in assessing and interpreting patients’ insurance coverage, pre-authorization and insurance procedures preferred.
Responsibilities
- Assists director and manager in determining and tabulating reimbursement for groups of patients who have been part of a new or special therapy program.
- Assists with follow up as needed on issues that arise.
- Assists the patient, family and/or caregiver in understanding of their insurance coverage specific to therapy services. Provides education for patients families regarding the need to understand deductibles, co-pay amounts, co-insurance amounts, diagnostic.
- Assists with training and education of outpatient therapist staff.
- Functions as an outpatient rehabilitation super-user, insurance lead, and resource to staff.
- Educates new clerical staff in proper procedures to ensure insurance coverage.
- Establishes and maintains systems for verification and monitoring of individual patient insurance coverage, number of authorized visits for therapy, etc.
- Interacts with insurance companies to determine coverage, as an advocate for the patient.
- Meets regularly with director and manager to discuss insurance issues and analyzes reimbursement and denials.
- Monitors trends associated with insurance carrier payer requirements for authorization, referrals, coordination of benefits forms and in network verification.
- Participates and supports department performance improvement initiatives and assists with accurate data collection in support of quality performance improvement.
- Participates in data collection and in-depth analysis of insurance reimbursement and denials to improve processes, develops preventive plans, and educates others.
- Reviews the integrity of the outpatient medical record. Audits the electronic medical record for accuracy of secretarial entries, scans, and other chart elements.
- Seeks out and communicates with members of Patient Access and Patient Accounts to ensure accurate registration, and to increase and share knowledge.
- Works closely with Rehabilitation Manager and Director to standardize documentation and tracking of all communications with insurance companies.
- Works in conjunction with each patient’s therapist to ensure authorizations for each planned visit.
- Works to reverse individual patient insurance payment denials when possible, including analysis of cause, submission of requests for retroactive authorizations as needed, etc.
- Performs all other functions of Rehabilitations Services secretary.
Benefits
- Medical Plan
- Prescription drug coverage & In-House Employee Pharmacy
- Dental Plan
- Vision Plan
- Flexible Spending Account (FSA) - Healthcare FSA - Dependent Care FSA
- Retirement Savings and Investment Plan
- Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
- Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
- Disability Benefits – Long Term Disability (LTD)
- Disability Benefits – Short Term Disability (STD)
- Employee Assistance Program
- Commuter Transit
- Commuter Parking
- Supplemental Life Insurance - Voluntary Life Spouse - Voluntary Life Employee - Voluntary Life Child
- Voluntary Legal Services
- Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
- Voluntary Identity Theft Insurance
- Voluntary Pet Insurance
- Paid Time-Off Program
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
501-1,000 employees
