Representative - The Longstreet Clinic - Revenue Cycle

Northeast Georgia Health System•Gainesville, GA

About The Position

Under the supervision of the Patient Access Service Center Supervisor/Manager, the Representative helps deliver outstanding customer service while scheduling appointments and completing pre-registration. The position gathers accurate patient demographic and insurance information, verifies eligibility and benefits, obtains pre-certification approvals, determines patient and insurance responsibility, collects applicable payments, and provides or refers patients for financial counseling when appropriate. The Representative enters scheduling information for assigned areas, which may include OR, Cardiology, and Radiology; coordinates procedure times; checks medical necessity; handles insurance verification and authorization; and documents relevant account details in the appropriate systems. The role also supports patients, Physician offices, and ancillary departments, responds to incoming calls, and meets department expectations 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 appointment times and schedule procedures promptly while allowing adequate time for insurance verification and authorization.
Perform medical necessity checks when applicable and complete ABN notification when medical necessity requirements are not met.
Obtain accurate insurance information and verify insurance eligibility and benefits by contacting patients, Physician offices, and payers.
Follow standard operating procedures during ADT or system downtimes.
Review patient history in Patient Access Systems to avoid duplicate medical records.
Capture and document pertinent patient demographic, subscriber, guarantor, and insurance information in the ADT system, including policy details, effective dates, copays, deductibles, out-of-pocket amounts, coinsurance, and coverage percentages.
Review work for accuracy, including procedure, patient type, pavilion code, insurance, and demographic information.
As assigned, obtain authorization for scheduled and non-scheduled inpatient and outpatient accounts within organizational and payer time frames, and document pre-certification appropriately and promptly.
Assess financial responsibility, communicate applicable financial 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 with scheduling, pre-registration, and pre-certification.
Answer and manage incoming calls and meet customer-service standards and assigned call-related goals.
As assigned, review accounts for order accuracy and contact Physician offices about discrepancies or concerns regarding scheduled appointments.
As assigned, index and label faxed Physician orders promptly and efficiently.
Use systems appropriately for scheduling, pre-registration, insurance verification, estimations, electronic orders, pre-certification, and phone quality controls.
Meet department goals, including productivity, accuracy, collections, and customer satisfaction.
Perform related duties and any additional department-specific duties assigned by management.