Company :

Job Description :

GENERAL OVERVIEW:

Performs all scheduling/pre-registration functions, verifies health insurance coverage, obtains detailed benefit information, validates authorization, calculates, collects and posts patient liabilities. Communicates revenue cycle related issues as needed. Contacts patients/physician offices, case managers and/or social workers to obtain complete and accurate demographic and insurance information.

ESSENTIAL RESPONSIBILITIES:

• Utilizes applicable worklists, faxes and phone calls to conduct scheduling/pre-registration functions, provides necessary pre-procedure instructions, validates patient demographic data, performs ABN check to determine medical necessity, verifies and obtains detailed medical benefits, assigns accurate plan code and COB order. Corrects/updates all necessary data to assure timely and accurate bill submission. Verifies all insurance information through payer contact via telephone or online resources. Notifies patient placement for bed assignment as applicable. (50%)
• Identifies payer authorization/referral requirements. Provides appropriate documentation and follow up to physician offices, scheduling/registration departments, case management department and/or payers regarding authorization/referral deficiencies. (15%)
• Identifies all patient financial responsibilities, calculates estimates, collects liabilities, communicates liability estimation to patient, post payment transactions as appropriate in the ADT system and conducts daily reconciliation of cash received for management review/sign off. After thorough investigation, identifies selfpay accounts and complex liability pricing calculations and escalates account to financial counselors as applicable. (15%)
• Maintains strict adherence to and compliance with all internal and external policies, procedures, rules, regulations, patient confidentiality and HIPPA privacy. Remains current on all regulations, policies and procedures and process changes that are essential to completing assigned daily tasks. (10%)
• Cooperates with and maintains excellent working relationships with patients, WPAHS leadership and staff, physician offices and designated external agencies or vendors. Performs any written or verbal communication necessary to exchange information with designated contacts. (10%)
• Performs other duties as assigned or required.

QUALIFICATIONS:

Minimum

• 1 year patient access/healthcare experience
• 1 year excellent customer service and communication skills
• Experience operating PC and using software and various website applications

Preferred

• Associate's Degree
• 2 years patient access/healthcare experience
• Knowledge of health insurance benefits
• Experience with telephone interaction to obtain information/collect patient liabilities

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

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