Representative - The Longstreet Clinic - Revenue Cycle

Northeast Georgia Medical Center•Gainesville, GA

About The Position

The Representative supports the Revenue Cycle at The Longstreet Clinic and, under the supervision of the Patient Access Service Center Supervisor/Manager, provides customer service while scheduling and pre-registering patients. The role gathers and documents accurate demographic and insurance information, verifies eligibility and benefits, obtains pre-certification approvals, identifies financial responsibility, collects applicable pre-service payments, and provides financial counseling or referrals when appropriate. The Representative coordinates with patients, Physician offices, insurance payers, and ancillary departments to ensure appointments and accounts are accurate and authorized within applicable time frames. The role uses scheduling, pre-registration, insurance verification, estimation, electronic order, pre-certification, and phone quality-control systems, and is expected to meet department goals for productivity, accuracy, collections, and customer satisfaction.

Requirements

High School Diploma or GED.
Ability to work independently, demonstrate emotional maturity, and function effectively under stress.
Good communication skills and excellent written and oral communication skills.
Excellent problem-solving and analytical skills.
Ability to prioritize, organize, and coordinate daily workload.
Working knowledge of Protected Health Information.
Ability to manage change.
Detailed understanding of insurance guidelines and protocols, full verification components, and payer information and requirements.

Nice To Haves

Two years of previous hospital registration or business office experience.

Responsibilities

Enter patient, procedure, diagnosis, and insurance information into the scheduling system for assigned areas, including OR, Cardiology, and Radiology.
Identify available procedure times and schedule promptly while allowing time for insurance verification and authorization.
Perform applicable medical-necessity checks and complete ABN notification when medical necessity requirements are not met.
Obtain accurate insurance information and verify patient eligibility and benefits with patients, Physician offices, and payers.
Follow standard operating procedures during ADT/system downtimes.
Review patient histories across Patient Access Systems to prevent duplicate medical records.
Capture and document relevant patient demographic, subscriber, guarantor, payer, and insurance details, including coverage and financial terms, in the ADT system.
Review work for accuracy, particularly procedure, patient type, pavilion code, insurance, and demographic information.
As assigned, ensure scheduled and non-scheduled inpatient and outpatient accounts are authorized within organizational and payer guidelines, and document pre-certification promptly and appropriately.
Assess patient financial responsibility, communicate applicable liabilities before service, collect pre-service payments, explain the facility billing process, and refer patients for financial counseling when appropriate.
Work with Physician offices and ancillary departments to support patient satisfaction in scheduling, pre-registration, and pre-certification.
Answer and manage incoming calls and meet assigned outbound-call and call-handling goals and customer-service standards.
As assigned, review orders for accuracy and contact Physician offices about discrepancies or concerns.
As assigned, index and label faxed Physician orders promptly and efficiently.
Use relevant scheduling, pre-registration, insurance verification, estimation, electronic order, pre-certification, and phone quality-control systems appropriately.
Meet department goals, including productivity, accuracy, collections, and customer satisfaction.
Perform related duties and any additional department-specific duties assigned by management.