Job Description

\rJob Description \r

Obtains accurate third party billing information. Educates and assists patients in regards to their insurance coverage as it pertains to their course of treatment. Facilitates revenue cycle reconciliation and reimbursement by working with all corresponding departments.

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Job Responsibility

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* Obtain daily schedules for outpatient consultations, follow up visits and inpatient admissions.
* Conduct phone interviews with patients prior to treatment. \r
- Obtain patient's insurance information.
- Inform/assist patients in obtaining necessary referrals/authorizations prior to date of service.
- Review general billing practices.
* Pre-admit into Series system.
* Verify insurance coverage by phone or by utilizing available verification systems such as IVANS, Epaces, Emdeon Assistant and the Internet.
* Pre-certify/authorize services by telephone, fax or web. Enter authorization number and collection notes into Series system.
* Conduct a face to face interview with patient on day of treatment. \r
- Educate patient on their insurance coverage as it pertains to their course of treatment including referrals, pre-certs, co-pays, cost share and deductible.Collect co-pays/deductibles.
- Inform patients of hospital fee and associated professional component fees.
* Interview all patients with insufficient third party coverage in order to determine their ability or lack of ability to pay.
* Determine patient potential eligibility for Medicaid and refer to appropriate personnel with proper documentation requirements for application submission.
* Determine patient eligibility for Financial Assistance and complete Financial Assistance application accordingly.
* Inform patients of their financial responsibility if they do not have coverage and are ineligible for any assistance, and complete payment agreement as needed.
* Prepares itemized bills for patients or insurance companies as needed.
* Attend physician presentations on all new and existing treatment protocols to keep informed of updates on available treatments.
* Confer with clinicians when non-conventional treatment is being considered and guide patients through the financial aspects.
* Communicate with case managers at insurance company. \r
- Supply necessary medical documentation to begin or continue treatment.
- Supply clinical trial documentation for non-conventional treatment.
- To establish out of network benefits for non-participating Managed Care coverage.
* Responds timely to all written and oral correspondence from third parties, patients, and or family members.
* Ongoing communication with all professional components billing representatives to coordinate insurance coverage and referrals/authorizations for treatment.
* Ongoing communication with Patient Accounts, entry of collection notes, patient maintenance, trial balance, follow-ups as needed.
* Interacts with patients and family members and provides emotional support as necessary, requests intervention of Social Work when appropriate and accepts referrals from Social Services when patient and/or family express concern of financial burden.
* Exercises prudent judgment regarding all daily communication with physicians, third parties, patients and family members and consults with Manager as needed.
* Required to maintain effective communication with the immediate management and staff of their assigned clinical area and adhere to their office policies and procedures.
* Required to maintain effective communication with Patient Financial Services Manager or Asst Director.
* Responsible for coverage of counterparts in other assigned Clinical areas.
* May perform other duties of patient accounting and /or other patient financial services staff as needed.
* May be required to travel/visit other departments within the hospital or other hospital sites located off campus.
* Required to train and mentor new employees.
* Utilizes Ontrac tool appropriately.
* Completes reporting tool applicable to assigned clinical area.
* Meets KPI indicators as indicated in Stockamp Situation Response Training.
Performs related duties as required.

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*ADA Essential Functions

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PHYSICAL DEMANDS:

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Required to lift, carry, pull, and reach approximately 10-25 lbs at least twice daily
Ability to file and retrieve files from or on top of file cabinets, shelves and transfer file boxes between six inches low and five feet high.

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Job Qualification

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High School Diploma or equivalent. Associate's degree, preferred.
Minimum six (6) months medical billing, insurance verification, financial counseling and /or experience in the healthcare field, required.
Ability to read and write English. Ability to type 40 wpm, edit and proof business correspondence, computer routines and prepare reports.
Knowledge of Microsoft Word, Excel, email, billing applications and Internet required. \r