Job Category:

Clinical Support

Work Shift/Schedule:

Varies

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

Under the supervision of the Patient Access Service Center Supervisor/Manager, this position is responsible for ensuring the delivery of outstanding customer service while scheduling, obtaining complete and accurate patient demographic information, identifying patient benefits and eligibility, obtaining pre-certification approvals from insurance companies and Physicians offices, identifying insurance and/or patient responsibility, collecting identified co-pay/deductible and/or providing financial counseling when appropriate, and completing the pre-registration process.
 

Minimum Job Qualifications

• Licensure or other certifications:

• Educational Requirements: High School Diploma or GED

• Minimum Experience:

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications:

• Preferred Educational Requirements:

• Preferred Experience: Two(2) years previous hospital registration/business office experience

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Ability to work independently, emotionally mature, and able to function effectively under stress

• Good communication skills

• Excellent problem solving and analytical skills

• Excellent written and oral communication skills

• Ability to prioritize, organize, and coordinate daily work load

• Working knowledge of Protected Health Information

• Ability to manage change

• Must possess detailed understanding and knowledge of insurance guideline and protocols, the components of full verification, and payor information / requirements

Essential Tasks and Responsibilities

• Responsible for data entry into scheduling system (for OR, Cardiology, and Radiology areas as assigned) including all information obtained from patient, Physician, and/or surgery staff. This data is including, but not limited to, correct procedures, diagnosis codes, and patient insurance information.

• Responsible for identifying available times for scheduled procedures; ensures prompt scheduling to meet the convenience of patients, however, allows adequate time to complete insurance verification and authorization process as efficiently as possible without compromising the procedure.

• Performs medical necessity checks on all appointments in which it is applicable; completes ABN notification upon any failure to meet medical necessity.

• Obtains complete and accurate insurance information and completes insurance verification by contacting patients, Physician offices and insurance/payer regarding the visit; verifies patient’s insurance eligibility and benefits with the information obtained.

• Works according to standard operating procedure during ADT/system downtimes.

• Identify patient's history in all Patient Access Systems to avoid duplication of medical records.

• Responsible for capturing and documenting all pertinent patient demographic, subscriber, and insurance information i.e.; patient policy and ID numbers, subscriber, guarantor, payor address, phone number, and contact information. Documentation must include, effective date, copay, deductible, out of pocket, co-insurance, percentage of coverage and any other pertinent information concerning the specific hospital visit into the ADT system.

• Reviews work and assures accuracy in all aspects of the position; particularly, procedure scheduled, patient type, pavilion code, insurance information, and demographic information to minimize error rate and time delays in other areas.

• As assigned, responsible for assuring all scheduled and non-scheduled inpatient and outpatient accounts are authorized either in advance or on the day of the service/admission date and within the time frames and guidelines set forth by the organization and payer; pre-certification is expected to be documented timely and appropriately.

• Responsible for assessing financial responsibility for scheduled patients; communicates financial liabilities to patients prior to service date when applicable; collects pre-service payments; educates patients on billing process for the facility; refers patients for financial counseling if applicable.

• Responsible for wo