Patient Access Representative Insurance Specialist Privia Infusion Center

**THIS VACANCY IS A PART TIME POSITION 810 HOURS PER WEEK**

Overview of the Role:

The Patient Access Representative Insurance Specialist (PARIS) has responsibilities across various business units of Privia Medical Group Gulf Coast (PMGGC) as assigned by PMGGC Management.  Duties will generally conform with the below descriptions and fall into the areas of patient benefits determination and verification and revenue cycle management responsibilities. 

Duties will vary somewhat with each specific assignment and will be outlined prior to assignment.  As of the date of this job description the below are the outlines of some specific current and potential responsibilities.  

Infusion Center Ancillary Job Duties:

The Patient Access Representative is responsible for all communications with the patients of the infusion center regarding their insurance and/or patient account with Privia Medical Group Gulf Coast as well as all communications with third party payers regarding benefits and/or payment of services. Duties include but may not be limited to:

• Obtain prior authorization for infusion treatment. Prior Authorizations must be submitted to insurance  for approval within 2 business days of receipt request.

• Enter or scan all actions related to the patients account into an electronic medical record including the prior authorization forms submitted to insurance companies when they are faxed for authorization.

• Obtain physician referral prior to infusion.

• Review upcoming appointments 1 7 and 30 days before scheduled services to obtain benefits verifications and referrals for infusion.

• Collect deposits deductibles and/or copays from the responsible party. Work with patients to make financial arrangements.

• Respond to patient requests regarding information on their account.  Explain financial policy and procedures as needed.

• Respond promptly to payer (insurance company employer etc. calls and correspondence related to patient services and claims.

• Work insurance claims to ensure prompt and accurate billing. Work to resolve coding or billing errors in order to effect accurate reimbursements and minimize patient liability.

• Complete all necessary forms and medical documentation as necessary for copay programs available through the drug companies. Submit required forms and documentation for prompt payment.

• Coordinate with other infusion center staff to seek patient account resolutions.

• Follow up on unpaid and underpaid claims to effect complete reimbursement by the payer/patient. Resubmit or correct and submit claims  or submit appeals as required.

• Audit all patient account transactions for accuracy and resolve any outstanding issues. Identify and correct billing errors.

• Communicate with clinical staff and physicians regarding outstanding issues related to patient accounts.

• Use approved collection correspondence and/or calls to patients to effect collection of

• patient responsibility.

• Audit all patient credit balance accounts for resolution.

• Make recommendations to the manager concerning accounts to be passed to thirdparty collection or to be adjusted as uncollectible.

• Privia Care Center Job Duties

  The Patient Access Representative Insurance Specialist may be assigned special projects designed to help PMGGC care centers with specific issues related to claims production and/or collections benefits verification staff education or other revenue cycle management related issues.  The PARIS will work closely with and under the direction of the Privia Health Gulf Coast Director of Revenue Cycle Management on the scope and details of such assignments.

• Complete the Margin Analysis & Allowables report for infusion center no later than 23rd of the month preceding a new calendar quarter review as actual reimbursements are received in each quarter to determine if drug costs and reimbursements are aligned with projections.

• Audit all patient account transactions for accuracy and resolve any outstanding issues.

• Identify and correct billing errors.

• Check daily the payments posted by Athena for accuracy.

• Contact patients after authorizations are obtained to explain benefits and coordinate payments prior to the first infusion appointment.

• Perform end of the month inventory of drug supplies.

• Order office supplies and scan packaging slips to appropriate departments.

• Participate in educational and developmental activities.

• Attend meetings as requested.

• Perform other duties as directed by the supervisor.

Qualifications :

• At least five years comprehensive experience in a medical/physician office environment.

• At least five years medical collections experience.

• At least three years working knowledge of CPT and ICD10 coding standards. 

• Comprehensive knowledge of clinical registration patient accounting billing reimbursement and third party payer/managed health care procedures and practices.

• Knowledge of clinical departments and operational relationships. 

• Knowledge of and ability to use CPT and ICD10 coding standards. 

• Understands advanced level of medical office terminology. 

• Skilled in analyzing accounting billing coding and third party payer reports. 

• Ability to perform mathematical computations and compute ratios and percentages.

• Skilled in defining problems collecting data interpreting billing information. 

• Skilled in using medical software computer applications. 

• Ability to organize work for the highest level of efficiency. 

• Ability to communicate clearly and be self motivated. 

• Ability to develop and maintain positive effective relationships with patients and staff.

Education/Certificate/License

• High School Diploma or GED; some college preferred.

The hourly compensation for this vacancy is $28 per hour.

Additional Information :

All your information will be kept confidential according to EEO guidelines.

#LIDNI

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age color national origin physical or mental (dis)ability race religion gender sex gender identity and/or expression marital status veteran status or any other characteristic protected by federal state or local law.  

Remote Work :

No

Employment Type :

Fulltime