Receives accounts and/or schedules for review and work-up regarding preadmission, admission, or add-on procedures, and services. Interviews patients for necessary account follow-up, to obtain accurate and detailed demographic, and financial information. Verifies insurance information, benefits, and initiates medical certification; reviews medical necessity, and assures that authorization is noted on file with supporting reference for the appropriate procedure, service, and/or patient status.
Receives, reviews, and completes necessary follow-up for encounter denials. Notifies patients of financial responsibility; explains and reviews insurance coverage, and collects patient’s responsibility via phone, or at time of service, to include initiation of payment arrangements if needed, or as required. Major Job Functions The following is a summary of the major essential functions of this job.
The incumbent may perform other duties, both major and minor, that are not mentioned below. In addition, specific functions may change from time to time: Contacts and interviews patients, responsible parties and insurance companies regarding hospital or ambulatory service to secure insurance benefits. Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms (EDI transactions, web access and by calling payers) and documenting information within the appropriate registration system, supporting with reference number.
Determines the need for appropriate service authorizations (pre-certifications, 3rd party authorizations, referrals) and contacts the payer, physician and/or case management/utilization review personnel, as necessary. Ensure authorization matches test(s) ordered Pre-registers the patient for upcoming visit(s) including validating/obtaining and entering demographic, financial, and insurance information. Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance.
Contacts physicians/office staff for clarification, if cases require clarification of diagnosis and/or test(s)/procedure(s). Informs patient/guarantor of their liabilities and collects appropriate patient co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration. Calculates patient liabilities and provides financial education, referring the patient to resource counseling, as required.
Documents payments/actions in the patient accounting system and provides the patient with a payment receipt. Assists patient with payment arrangements as needed for remaining balance. Properly screens appropriate patients for market insurance.
Obtains signed physician orders for scheduled tests and procedures from physicians/offices for testing and procedures, and scans into electronic record. Completes appropriate follow-up on insurance denials and initiates appeal, retro-authorization, etc. as needed. Assists insurance companies, physician, and physician practices, and or hospital departments with patient information in accordance with HIPAA guidelines.
Meets or exceeds accuracy standard goal determined by Patient Access Leadership; Ensures integrity of patient accounts by working error reports daily, entering accurate data, and documenting all attempts made to collect and or obtain missing documentation. Other duties as assigned
The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job: Education and Formal Training : High school graduate or equivalent required Associates Degree in Business or Health Care Administration and/or Computer Technology preferred Patient Access Specialist certification (CPAS) required within 1 year of employment Work
1 year insurance/clerical experience within a hospital or medical office setting Knowledge, Skills, and Abilities Required : Proficiency in reading, writing, and speaking the English language Knowledge of insurance and collection of payments Knowledge of Medical Terminology Knowledge of Microsoft software Excellent verbal and written communication skills, customer service skills and problem-solving abilities Ability to appropriately handle complexity and stress with the changing needs of the patients, families, visitors, and the Health System.
May be required to periodically rotate shifts and regular days off All system employees must have the flexibility to meet the department hours of operation Physical
Must be able to communicate orally, see, and hear to collect information Must have dexterity to operate office equipment. Position operates in an office, call center environment The incumbent is subject to eyestrain due to the many hours spent looking at a CRT screen. The noise level is low to moderate.
Bends, reaches, pushes and pulls file drawers to file records and reports. Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds. Required Licenses and Certifications CPAS - Healthcare Business Insights Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity