Imaging Services Representative

About the Role

The Imaging Services Representative is responsible for managing incoming and outgoing calls for Catholic Health Radiology service line. They will support the Catholic Health system by scheduling and collecting all necessary demographic and financial information to ensure streamlined access to care and throughput for radiology services. The Representative will ensure the patient has active insurance coverage, collect demographic information, acquire and explain benefit information, confirm patient responsibility amounts, and secure authorization for services. They will communicate policies, protocols, and instructions relevant to the service being scheduled, providing a positive patient experience.

Responsibilities

• Registration:
  • Utilize workqueues/workdrivers and reports as assigned by management to complete daily tasks.
  • Interview patients to verify and/or obtain demographic, insurance, employer, and general encounter information.
  • Confirm with the patient/responsible party the need for pre-certification and/or authorization for tests. Documentation into Epic.
  • Notify patient or patient representative of the expected out-of-pocket expenses (deductible, copayment, non-covered service). Request payment for the patient's out-of-pocket responsibility while the patient is on the phone.
  • Educate the patient on pertinent policies, protocols, and instructions as necessary.
  • Confirm initial and subsequent authorizations.
  • Utilize analytical, problem-solving skills to determine the best course of action to resolve any problems. Keep Supervisor informed of any potential services that may be at financial risk.
  • Propose innovative ideas and solutions to enhance operational efficiencies.
  • Maintain knowledge of scheduling guidelines, facility structure, and navigating situational responses.
  • Validate appropriate demographic, clinical, and financial information has been collected to ensure an excellent patient experience.
  • Comply with Medical Necessity protocols and proper use of Compliance Checker and National Coverage Decisions.
  • Maintain knowledge of payer regulations and collection policies.
  • Stay abreast of changes in Medicare, Medicaid, and third-party payer reimbursement requirements.
• Scheduling & Pre-Registration:
  • Contact patients to coordinate the scheduling of appointments for various services and complete the scheduling process in EPIC.
  • Collect necessary data to create a complete and accurate preregistration for scheduled appointments.
  • Verify insurance activity via insurance eligibility systems to confirm active status.
  • Communicate with Financial Counselors, physician offices, patients, Financial Clearance Center, and PAS staff to ensure accuracy of orders and securing of appropriate authorizations.
  • Follow department-specific scheduling guidelines and insurance parameters when scheduling appointments.
  • Appropriately communicate to patients any relevant appointment instructions.
• Insurance Verification:
  • Confirm that a patient’s health insurance(s) is active and covers the patient’s procedure; may be completed multiple times before, during, and after a patient’s visit/stay.
  • Document a patient’s health insurance benefits and coverage for their visit, including effective date of the policy, product line, coverage limitations/requirements, and patient liabilities for the type of service(s) provided.
  • Check benefits to determine deductible, coinsurance, and copayment amounts due.
  • Use procedure estimate process/program to notify the patient of the amount due. Make patients aware of financial obligations and appropriately refer them to financial counseling when necessary.
  • Collect co-payments, co-insurance, deductible, and self-pay fees prior to or at the point of service. Document collections in the system and on a daily collection log, and provide the patient with a receipt.
  • Verify a patient’s network status (in or out-of-network) with their plan and communicate to the patient in advance if an out-of-network status applies.
  • Ensure payer requirements are met, including verifying and documenting insurance eligibility, confirming and documenting benefits, reviewing clinical documentation, and securing authorizations.

Qualifications

• High School Diploma or Equivalent
• Minimum of 1 year of experience in Revenue Cycle Management or Patient Access Services functions

Skills

• Comprehensive understanding of insurance, pre-certification requirements, and medical terminology
• Ability to access online insurance eligibility and pre-certification systems
• Customer-focused with strong interpersonal skills, courtesy, and tact
• High level of problem-solving skills
• Ability to interpret and execute policies and procedures
• Working knowledge of personal computers and standard office equipment
• Positive demeanor, good verbal and written communication skills, and professional appearance and approach
• Ability to handle potentially stressful situations and multiple tasks simultaneously

Pay

USD $24.00 - USD $30.00 /Hr. This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies, and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

Benefits

Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.