Central Access Pre-cert Rep, M-F, 9a-5p

Job Summary

The Central Access Precert Rep is responsible for scheduling, securing patient demographic and insurance information; verifying insurance eligibility and benefits, obtaining and securing pre-certification and clinical documentation obtained and validated. Strong emphasis of managing scheduled cases less than 24 hours and same day add-on cases. Position demonstrates ability to interpret Local Coverage Determination and National Coverage Determinations or commercial contract requirements necessary for pre-certification or authorization.

About the Role

• Manage heavy call and schedule volumes.
• Notify patients of their financial obligation and collect co-pays, deductibles, deposits and other identified out-of-pocket liabilities or deposits on accounts as required.
• Support the department in meeting the pre-collections goals defined by Revenue Cycle management.
• Review accounts with inadequate financial coverage for the purpose of coordinating with the Central Access Financial Advocate.
• Interact with physicians or their office designee and with Erlanger's clinical department leaders as necessary to financially clear the patient for the next day of service.
• Demonstrate professionalism as reflected by courteous actions, maintenance of confidentiality and appropriate presentation of self.
• Exhibit excellent oral and written communication skills.
• Interact appropriately with third party payers and other departments.
• Relate well to people of a broad socio-economic mix.

Responsibilities

• Answering incoming phone calls and scheduling outpatient appointments.
• Pre-register scheduled patients by gathering all patient demographic and financial information.
• Verify insurance eligibility and benefits for scheduled outpatient and inpatient patients.
• Validate and initiate pre-certification.
• Compute patient liability.
• Communicate and initiate time of service collections.
• Review prior bad debts and request payment of outstanding prior bad debt.
• Alert Financial Advocates of accounts with financial clearance issues.
• Document patient liability and financial clearance status to ensure timely processing at the point of service.
• Complete pre-registration, insurance verification and financial clearance for special admission and transfer patients.

Requirements

• Education: High School or Equivalent.
• Experience: Three years work experience in either a governmental or commercial insurance provider office with call center experience or two years experience as a Central Access Specialist I or as an Pt Access Specialist II with proven work outcomes and no current disciplinary actions within the past year.
• Skills: Strong Medical terminology, moderate knowledge of CPT and ICD-9 codes, insurance coding and billing knowledge, strong computer skills, excellent customer service skills and interpersonal communication and telephone etiquette, ability to relate well to people of a broad socio-economic mix, strong organizational skills, ability to multitask, work in a fast pace environment, manage a multi-line phone system, and commitment to teamwork.

Qualifications

• Licenses/Certifications/Registrations: License/Certification/Registration Required - Certified Healthcare Access Associate from NAHAM.

Preferred

• Bilingual.

Position Requirement(s)

• Computer, fax machine, copier, multiline telephone.
• Ability to multitask and manage high volumes.
• Self-starter and demonstrated ability to prioritize work and manage multiple tasks in a sometimes stressful environment.

Pay

Standard Hours: M-F, 9a-5p

Schedule

Central Access Pre-cert Rep, M-F, 9a-5p

Erlanger Baroness Hospital Chattanooga, TN