Employment Type:

Shift:

Description:

Responsible for the complete and accurate collection of patient demographic and financial information for the purpose of establishingthe patient and service specificrecord for claims processing and maintenance of an accurate electronic medical record. Registers and checks-in patients and determines preliminary patientand insurance routine account analysis and problem solving. Resolves patient account issues. Initiates billing and rebilling of accounts as appropriate. Under limited supervision; determines need for and obtains authorization for treatment /procedures and assignment of benefits information to patients concerning regulatory point of service provides estimated costs and patient responsibility facilitating collection of co-pay deductible and private paybalances.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

Obtains verifies and enters patient identification demographic information and insurance coverage into hospital information system(s) to ensure accurate and timely submission of claims.

Determines visit-specific co-payments and collects out-of-pocket liabilities.

Assists patients with questions regarding financial liability or refer to appropriate resource(s).

Inform patients on cost of treatment insurance benefits resources for payment and financial assistance. Secures and documents payment arrangements.

Obtains medical authorization or referral forms if appropriate. Audit authorizations for accuracy and determine if delay/deny policy needs to be invoked.

Utilizing key reports and tools to facilitate obtaining accurate insurance information.

Educates patients/families on the use of registration kiosks or online systems.

Identifies non-routine complex issues and escalates to Patient Access Lead for resolution.

Assists in the training and education of colleagues upon hire and ongoing as new systems and processes are created.

Maintains compliance with HIPAA and other regulatory requirements throughout all activities. Protects the safety of patient information by verifying patient identity to preserve the integrity of the patient record and ensures all records are complete accurate and unique to one patient.

Is proficient at the use of automated tools and makes appropriate decisions related to the relationship of the action required and the tool used. Performs pre-registration and pre-admits.

Communicates frequently with patients/family members/guarantors and physicians or their office staff in the deployment of key activities. Interviews patients to collect data initiates electronic medical records validates and enters data related to procedures tests and diagnoses. Determines need for appropriate service authorizations (pre-certifications third-party authorizations referrals) and contacts physicians and Case Management/Utilization Review personnel as needed. Obtains and verifies the accuracy and completeness of physician orders for tests and procedures which includes name date of birth diagnosis procedure date and physician signature to minimize risk to hospital reimbursement. Accurately uses the patient search feature to find the correct patient information and disseminates data to clinical systems for patient care. Identifies required forms or templates based on the types of services patients will receive.

At point of service performs insurance eligibility and determines benefit verification utilizing EDI transactions and payer web access and calls payers directly. Documents information within the patient accounting system through insurance eligibility/benefit verification. Refers accounts identified as self-pay to benefit advocacy resources. Conducts data search of previous accounts or payment source history when appropriate.

Provides financial information and patient payment options. Informs patient/guarantor of liabilities and collects appropriate patient liabilities including co-payments co-insurances deductibles deposits and outstanding balances at the point of pre-registration or point of service. Documents payments/actions in the patient accounting system and provides the patient with a patient estimate of out-of-pocket costs and a payment receipt in the collection of funds. Acquires and explains necessary documents including patient identification insurance cards consent for treatment assignment of benefits release of information waivers ABNs advance directives etc. Identifies need for patient/guarantor signature based on patient encounter/visit. Scans appropriate documents.

OTHER FUNCTIONS AND RESPONSIBILITIES

Cross trains in various functions to assist in the timely delivery of department services. Performs routine duties relating to patient placement which includes responsibility for bed assignments transfers and providing functional guidance as necessary.

Utilizes Scheduling Booking Reports Stop/Go Reports Schedules to facilitate daily patient activity and flow in support of the clinical departments. Analyze completeness and accuracy of records on these reports proactively and take action as appropriate.

Analyze and problem-solves issues related to revenue cycle elements (charges demographic information guarantor information insurance eligibility coordination of benefits authorization requirements) in response to patient inquiries and issues. Works to resolves these issues in a timely and appropriate manner including assisting with submission of patient centered claims to insurance carriers.

Interprets data draws conclusions reviews findings and provides recommendations. Acts as subject matter expert and participates in special projects as directed by the Patient Access Lead.

Other duties as needed and assigned by the manager.

Maintains a working knowledge of applicable Federal State and local laws and regulations Trinity Healths Organizational Integrity Program Vision Mission Core Values Standards of Conduct as well as other policies and procedures to ensure adherence in a manner that reflects honest ethical and professional behavior.

Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems offer solutions and participate in their resolution.

Maintains the confidentiality of information acquired pertaining to patient physicians employees and visitors to St. Joseph Mercy Hospital. Discusses patient and hospital information only among appropriate personnel in appropriately private places.

REQUIRED EDUCATION EXPERIENCE AND CERTIFICATION/LICENSURE

Education:

High school diploma or an equivalent combination of education and experience. Associate degree in Accounting or Business Administration highly desired.

Experience:

Minimum of one year experience in a customer service role with financial responsibilities is required. Experience in health care insurance or managed care industries is highly preferred. Experience performing medical claims processing financial counseling and clearance or accounting is also highly preferred.

Certification/Licensure:

Completion of certification and skills competencies such as the Certified Revenue Cycle Specialist Professional (CRCSP) through the American Association of Healthcare Administrative Management (AAHAM) and/or Certified Healthcare Access Associate (CHAA) through the National Association of Healthcare Access Management (NAHAM) is preferred.

REQUIRED SKILLS AND ABILITIES

Must have experience with the core offerings of the Microsoft suite (Word PowerPoint Excel).

Strong communication skills both verbal and written

Strong critical thinking interpersonal and problem-solving skills.

Strong data entry and organizational skills. Must be accurate and possess high level of attention to detail. Able to work independently and have good time management skills.

High level of initiative. Able to work concurrently on a variety of tasks/projects in a fast-paced environment that is sometimes stressful with individuals that have diverse personalities and work styles.

Able to set and organize work priorities and then adapt as business needs change.

Able to comprehend and retain information and apply to work procedures to achieve appropriate service delivery.

Knowledge of insurance and governmental programs regulations and billing processes (Medicare Medicaid Social Security Disability Champus and Supplemental Security Income Disability) managed care contracts and coordination of benefits is highly desired.

Working knowledge of medical terminology anatomy and physiology and medical record coding (ICD-10 CPT HCPCS) is preferred.

Our Commitment

Rooted in our Mission and Core Values we honor the dignity of every person and recognize the unique perspectives experiences and talents each colleague brings. By finding common ground and embracing our differences we grow stronger together and deliver more compassionate person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability veteran status or any other status protected by federal state or local law.