Medical Biller - CBO Hospital Services - AR Follow Up

Essential Function

The Patient Access Representative will initiate authorization and benefits for patients. They will obtain and verify accurate identification and demographic data for the patient's permanent medical record which assists in accurate reimbursement while recognizing the necessity of maintaining the confidentiality of all patient information. The Patient Access Representative is responsible for obtaining authorization and benefits and interacting with the patients via telephone, and/or using the interpretative service when needed. The Patient Access Representative improves patient satisfaction through consistently representing LCMC professionally and cross-training to support multiple functions across all patient and payer types. They will interact with patients, doctors, pharmacies, nurses, and other clinic or hospital personnel both internal and external.

Required

• Completes the patient registration and admissions process and ensures all required forms are completed and other paperwork / documents are gathered and accurate: Requests and documents patient demographic, insurance, guarantor, MSP, and PCP/Referring Physician information and validates against current system
• Ensures patient/guarantor sign all applicable documentation, such as consents and financial assistance loan application
• Scans ID, insurance cards, orders, authorization information, etc. to patient’s account once the information is validated for accuracy
• Completes insurance verification tasks, including: running automated eligibility response at point-of-service to ensure active coverage and completing notification of admission with insurance company within established timeframe
• Contacts case management and/or provider to assist with appropriate department placement for clinical services
• Analyzes physician’s order for proper bed placement functions per policy when necessary
• Performs financial analysis of each case and informs patient of financial responsibility: Informs patient/guarantor of liability due, including prior balances and estimates for scheduled service
• Attempts to collect payment
• Refers to financial counseling as needed
• Maximizes point-of-service collection, meeting established registration collection goals
• Provides excellent customer service to all patients, guests and family members: Promotes a customer centered experience by performing all functions in a warm and courteous manner to patients, family members, providers, and all visitors of the organization.
• Answers incoming calls and transfers calls to appropriate areas of department/clinic/hospital.
• Schedules and reschedules appointments for patients as needed, identifying open time slots and educating patient/guardian about available options for services

Job Qualifications

• Education: A high school diploma or GED required
• Certification in billing and/or coding is preferred
• Experience: Minimum two years of experience in a healthcare environment, particularly in healthcare billing, collections, payment processing, or denial management is preferred
• Strong clerical experience considered
• Knowledge, Skills, Abilities: Must be able to pass basic computer skills test and system level training
• Working knowledge of system reports and the ability to analyze system information to determine the impact of possible changes
• Demonstrates knowledge of: Hospital and professional billing processes and reimbursement Third-party contracting Insurance protocols, delay tactics, systems, and workflows ERISA guidelines for denials and appeals Regulations related to denials and appeals Ability to take initiative by identifying problems, conceptualizing resolutions, and implementing change Possesses efficient time-management skills and proven ability to multitask under tight deadlines Demonstrates excellent customer service skills Effective writing and communication skills Strong comfort level with computer systems