Representative - Patient Access L1

POSITION SUMMARY The Patient Access Representative verifies demographic and insurance information, completes coordination of benefit changes, calculates patient estimates, verifies the accuracy of the surgery prior authorization, and collects patient financial obligations. The individual utilizes a complex skill set and verifies every scheduled patient surgery and is ultimately responsible for assisting patients and families. Works as a member of a team to ensure reimbursement for services in a timely and accurate manner.   ESSENTIAL FUNCTIONS Confirm valid coverage for services and location by contacting insurance companies and/or review electronic responses for benefit information Manage patient insurance demographic information to verify authorization obligations. Verify that service is a covered benefit, based on knowledge of the specific insurance plan, the specific benefit package restrictions, and the timing of the service Understand patient deductibles, out of network referrals and out of pocket limitations. Review the account and timing of last patient demographic query to identify missing standard and/or required information. If necessary, contact the patient to complete the information. Calculate and collect patient liability before or at the time of service. Communicate the liability and explain the calculation low and high amounts when necessary. Identify the potential need for assistance when the coverage/benefit is either inadequate or nonexistent for a medically necessary service, and if necessary, create a payment plan with the patient and document the agreement appropriately. Answer automated call center calls and determine whether an outbound call is necessary, either to the patient or to the insurance company. For a call back, assess the call and respond appropriately, attempting to resolve all patient inquiries Builds strong working relationships with assigned business units, hospital departments or provider offices. Identifies trends in payment issues and communicates with internal and external customers as appropriate to educate and correct problems. Provides assistance and excellent customer service to these internal clients. Responds to incoming calls and makes outbound calls as required to resolve billing, payment and accounting issues. Provides assistance and excellent customer service to patients, patient families, providers, and other internal and external customers   Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.   NOTE: The essential functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager.   MINIMUM QUALIFICATIONS High school diploma /GED or equivalent working knowledge. Requires knowledge of one or more of the following: patient financial services or collecting service processes normally acquired over up to two years of work experience. Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently. Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences. Strong knowledge in the use of common office software, word processing, spreadsheet, and database software are required.   PREFERRED QUALIFICATIONS Work experience with the Company’s systems and processes is preferred. Previous cash collections experience is preferred. Additional related education and/or experience preferred.   PHYSICAL DEMANDS/ENVIRONMENT FACTORS OE - Typical Office Environment: (Accountant, Administrative Assistant, Consultant, Program Manager) Requires extensive sitting with periodic standing and walking. May be required to lift up to 20 pounds. Requires significant use of personal computer, phone and general office equipment. Needs adequate visual acuity, ability to grasp and handle objects. Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone. May require off-site travel   SUPERVISORY RESPONSIBILITIES None DIRECTLY REPORTING Reports to the Supervisor – Patient Access TYPE OF SUPERVISORY RESPONSIBILITIES N/A   SCOPE AND COMPLEXITY Works independently under general supervision, following defined standards and procedures. Reports to a Supervisor or Manager. Uses critical thinking skills to solve problems and reconcile accounts in a timely manner. External customers include all ambulatory surgery center patients, patient families and all third-party payers. Internal customers include facility medical records and patient financial services staff, attorneys, and central services staff members.