POSITION SUMMARY
The Patient Access Representative verifies demographic and insurance information, completes coordination of benefit changes, calculates patient estimates, verifies the accuracy of the surgery prior authorization, and collects patient financial obligations. The individual utilizes a complex skill set and verifies every scheduled patient surgery and is ultimately responsible for assisting patients and families. Works as a member of a team to ensure reimbursement for services in a timely and accurate manner

Job Responsibilities

ESSENTIAL FUNCTIONS

• Confirm valid coverage for services and location by contacting insurance companies and/or review electronic responses for benefit information
• Manage patient insurance demographic information to verify authorization obligations.
• Verify that service is a covered benefit, based on knowledge of the specific insurance plan, the specific benefit package restrictions, and the timing of the service
• Understand patient deductibles, out of network referrals and out of pocket limitations.
• Review the account and timing of last patient demographic query to identify missing standard and/or required information. If necessary, contact the patient to complete the information.
• Calculate and collect patient liability before or at the time of service. Communicate the liability and explain the calculation low and high amounts when necessary.
• Identify the potential need for assistance when the coverage/benefit is either inadequate or nonexistent for a medically necessary service, and if necessary, create a payment plan with the patient and document the agreement appropriately.
• Answer automated call center calls and determine whether an outbound call is necessary, either to the patient or to the insurance company. For a call back, assess the call and respond appropriately, attempting to resolve all patient inquiries
• As assigned, reconciles, balances and pursues account balances and payments, and/or denials, working with payor remits, facility contracts, payor customer service, provider representatives, spreadsheets and the company’s collection/self-pay policies to ensure maximum reimbursement.
• Builds strong working relationships with assigned business units, hospital departments or provider offices. Identifies trends in payment issues and communicates with internal and external customers as appropriate to educate and correct problems. Provides assistance and excellent customer service to these internal clients.
• Responds to incoming calls and makes outbound calls as required to resolve billing, payment and accounting issues. Provides assistance and excellent customer service to patients, patient families, providers, and other internal and external customers

Required Skills and Qualifications

MINIMUM QUALIFICATIONS

• High school diploma/GED or equivalent working knowledge.
• Requires knowledge of patient financial services, financial, collecting services or insurance industry experience processes normally acquired over one or more years of work experience. Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently. Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences.
• Strong knowledge in the use of common office software, word processing, spreadsheet, and database software are required.

PREFERRED QUALIFICATIONS

• Work experience with the Company’s systems and processes is preferred. Previous cash collections experience is preferred. Additional related education and/or experience preferred.