Patient Access Representative - HORC (Hospice) - FT

Responsible for identifying insurance coverage and obtaining pre-certifications as well as assisting in receiving and data entry of referrals as indicated to ensure positive patient and agency outcomes.

Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

ESSENTIAL FUNCTIONS:

• Verifies insurance eligibility and benefits.
• Obtains pre-certification and ongoing authorizations with all insurance companies.
• Assists in the intake/ referral processes and staffing assignments as needed to ensure timely response to patient’s needs and to maximize staffing utilization.
• Maintains knowledge of federal, state and private regulations for reimbursement and data collection required by Center for Medicare and Medicaid Services (CMS), and other regulatory organizations and payers.
• Participates in insurance and regulatory required audits and data submission
• Facilitates processes to ensure compliance of certifications, PPOC and Face to Face requirements.
• Audits all admissions for intake requirements and all hospice and homecare patients for program specific conditions and quality reporting.
• Knowledge of regulations of the Face to Face per Medicare and Medicaid guidelines.
• Completes pre-billing and performance improvement chart audits as assigned.  
• Completes timely and accurate documentation as per agency policy.
• Promotes and maintains cooperation and communication with physicians and all staff and clientele to ensure satisfactory results in reimbursement.
• Participates in generation and transmission of notices of election and admission and other billing processes.
• Performs clerical support tasks relative to the needs of the agency including but not limited to receiving incoming phone calls, reviewing and processing of incoming faxes.

• Abides by the Health Insurance Portability and Accountability privacy and security regulations regarding all aspects of Protected Health Information (PHI).
• Performs other responsibilities as assigned, which are consistent with the goals and qualifications of this position

MINIMUM KNOWLEDGE AND SKILLS REQUIRED:

• Computer skills with advanced knowledge of medical record systems.

• Demonstrated ability to communicate effectively.
• Intermediate knowledge of Microsoft Office.
• Keyboarding skills, filing, data processing and general office work.

PREFERRED BEHAVIORAL SKILLS:

• Integrity:
  • A personal presence which is characterized by a sense of honesty and the willingness to do the right thing.
  • The ability to role model, inspire and motivate others to promote the philosophy, mission, vision, goals and values of Hutchinson Regional Healthcare System
• Compassion:
  • A personal presence which is characterized by a sense of caring that is reflected in a high level of empathy and customer service with all that we come in contact.
  • Ability to manage conflict, consider other points of view, and offer alternative solutions without jeopardizing overall project direction and the ability to manage customer expectations.
• Accountability:
  • Demonstrated track record of ownership of situations, projects and issues.
  • Able to work autonomously and have a high degree of flexibility to adapt to changing projects, priorities and work volumes.
• Respect:
  • Demonstrated ability to collaborate with a diverse population.
  • Treat all internal and external customers with a positive, proactive service orientation.
• Excellence:
  • Strong communication skills and the ability to service our customers with the highest of standards

MINIMUM EDUCATION AND EXPERIENCE REQUIRED:

• High School Diploma

PREFERRED EDUCATION AND EXPERIENCE:

• Medical Terminology
• Medical Office Experience
• Insurance Authorization Experience

REQUIRED LICENSE/REGISTRATION/CERTIFICATION:

• Valid State of Kansas driver’s license
• Proof of auto liability insurance in the State of Kansas

PREFERRED LICENSE/REGISTRATION/CERTIFICATION:

• Associate’s or Bachelor’s Degree in Health Care or Business

We offer competitive pay, a generous benefit package and a reason to be proud of what you do, every day.