Patient Financial Services

Requested work schedule: 7am-530pm w/Wed off

Required:
Minimum of one (1) year of experience in an admitting office, clinic, physician or insurance office performing patient registration and insurance verification
Previous EPIC Prelude and Cadence experience a plus.

Special knowledge, skills, & abilities:
1. Exceptional computer skills and the ability to quickly master multiple computer programs required.
2. Moderate understanding of Medical Terminology preferred.
3. Familiarity with contractual nature of HMO and/or PPO insurance plans, Medicare and Medicaid, commercial preferred.
4. Excellent interpersonal communication skills which convey a positive and supportive intent.
5. Exceptional customer service skills projecting a friendly and professional image.
6. Ability to work independently, self-directed and work with individuals with diverse background.
7. Must be capable of working under pressure with continuous telephone calls and constant interruptions.
8. Moderate knowledge of Microsoft Office Products and business and office machines such as: fax, telephone, computer/printer, copier; reception skills required.

9. Must have strong interpersonal skills and the ability and desire to work in a very busy, multidisciplinary setting.

10. Understands the principles of teamwork, and models a positive attitude, and the skills to engage in conversations that promotes problem solving and a positive exchange of individual ideas.

11. Must have good clerical skills, including typing (60 wpm), excellent telephone etiquette and good organizational and record-keeping skills.

12. Ability to maintain confidentiality of all information related to patients, medical staff, and employees and as appropriate other information.

13. Critical thinking and problem solving skills.

14. Must have appropriate manner, conduct and grooming and present a professional image.

Function:
1. Incoming and Outgoing Referral Processing:

• Verify insurance benefits and bariatric coverage for all patients to determine if patient eligible for program

• Completes and processes all authorizations and referrals ordered

• Accurately obtains and/or verifies referrals: ensures ICD-10 code and referral auth, if needed, are provided with the referral and accurately entered into Epic; checks patient medical benefits, and obtains pre-authorization or renewal of authorization as needed to ensure financial reimbursement for services provided by the department; (add something about for entrance into bariatric program, for all visits during program, and for surgery authorization)

• Transcribe orders: Ensures diagnosis, ICD-10 codes, and referral auth are provided with the referral and accurately entered into Epic

• Coordinates outgoing referrals by compiling necessary documents to be sent to external specialists and obtain insurance authorization if needed (specialist visit, imaging orders, etc)

• Contacting insurance companies, to solve and expedite referral processing barriers

• Assign referrals to visits

• Respond to provider questions and concerns for referral placement and processing.

• Maintains knowledge of primary and specialty practices: services, expectations for referrals, restrictions for referrals, and insurance requirements for referrals

2. Insurance Authorizations

• Interpret medical policies and relay changes to staff and patients

• Communication with patients and insurance companies to clarify and/or update insurance information and resolve insurance concerns

• Submit surgery authorization with pertinent medical records in a timely manner

• Verify specific plan requirements

• Verify authorization is correct (CPT code, surgeon, admission type, date of service, diagnosis)

• Ensure ABNs in place when needed

• Maintain self pay process

3. Scheduling, Registration, Check-in, and Phones

• Basic scheduling and registration knowledge.

• Provides direction and information regarding program and services

• Works with Professional and/ Hospital billing services, financial assistance, and other resources to assist patients with billing questions

4. Other Duties as Assigned

• Data tracking and interpretation

• Monitor incoming fax lines and distribute

• Completes work queue assignments within appropriate timeframes and assists others in completing work queue assignments as time allows.