Patient Access Representative - Patient Access Insurance Verification - Corporate Full-Time- Days (M-F & 1 Saturday Monthly)

Patient Access Representative - Patient Access Insurance Verification - Corporate Full-Time- Days (M-F & 1 Saturday Monthly)

Obtains complete and accurate demographic and insurance information by ensuring all relative data is collected. Interviews patients over the telephone, to make sure all information is secured and documented in the Eagle System. Answers phones courteously and efficiently.

• Accesses EPIC system to secure cases scheduled for ambulatory and in-patient procedures.
• Ensures that the appropriate authorization/predetermination requirements have been secured based on procedure & ICD10 codes booked by physician’s offices.
• Notifies patient/physician, via email, of insurance/pre-certification deficiencies that require immediate attention to secure patient account in a timely fashion.            
• Checks the IP only CPT List to ensure cases are booked in appropriate setting for Medicare and Medicaid Fee for Service as well as HMO, PCP payers.
• Secure additional information from the physician or patient to financially secure the account before releasing the case for final billing.
• Ensure that clear and consistent memo notations are posted on all actions taken on cases worked. Serves as proof of documentation for follow up needed if case is denied.
• Refer unsecured cases to management in addition to emailing the service area/physician to initiate follow up on securing the case. (Front End-Admitting/ Physician Offices)
• Refer underinsured / uninsured cases to Management as well as Financial Counseling Department as appropriate.          
• Pre-Admits patients in Eagle system, validate insurances booked to make sure they are active at time of registration, assign appropriate primary payer financial class based on verification. Refer to management / service area if insurance is inactive to secure case. 
• Review EPIC /IPATH schedule intermittently throughout the day to reconcile all cases, including last minute add on’s added to schedule to ensure they are also secured timely.
• Continuously refer back to service areas / management any case that does not meet criteria and is at risk for Denial.                
• Stat edits accounts registered 48 hours from service date to Ontrac to meet Department goal of remaining 3 to 5 days out secure.            
• Notifies the patient of any deposits or financial liability they are required to pay on date of procedure. Enter memo notations of patient notification.
• Obtains credit card number for said liability when possible, and contacts the patient to collect pre service at least one prior to service date.      
• Consistent accuracy in data entry a must (correct payer financial class) with a clear memo notation in Eagle to identify all steps taken to secure the services rendered.                   
• Refer to Management on all the cases that do not meet standards for patient access clearance. 
• Demonstrate an ability to organize and achieve quality performance with new routines, procedures.
• Demonstrate an ability to gather and maintain complete, appropriate collection of data to increase the overall efficiency at maximum potential.
• Secure complete insurance information, ie: rule out Dependent Coverage information which includes documenting COB confirmation and completion of required questionnaire documents.
• Ensuring Medicare MSP questions are documented in Eagle completely and accurately for auditing preparedness.             
• Consistently demonstrate the ability to recognize, establish and deal with priorities and seeking assistance from management as needed.      
• Maintains accurate reconciliation system for pre-admissions, admissions, and ambulatory surgeries.               
• Reviews and completes all the inflow accounts from EPIC / Ontrac work list and codes them timely and accordingly.     
• Possesses knowledge of third party insurance requirements as relates to in-patient, ambulatory surgery, and the maternity and behavioral health admissions       
• Processes and submit completed accounts in a timely basis according to the departmental needs as required.
• Listens closely to all the customers’ requests and concerns and follows through appropriately.   
• All other duties as necessary to financially secure patients accounts as assigned by management

• Applicable work experience may be considered in lieu of educational requirements. High school graduate or equivalent.