Description
GENERAL OVERVIEW :
This job completes one or more of the following processes (scheduling, pre-registration, financial clearance, authorization and referral validation and pre-serviceability estimations and collections) within Patient Access and creates the first impression of AHN's services to patients and families and other external customers.
Articulates information in a manner that patients, guarantors and family members understand so they know what to expect and understand their financial responsibilities.
Assumes clinical and financial risk of the organization when collecting and documenting information on behalf of the patient.
Trains and assists other team members as necessary.
ESSENTIAL RESPONSIBILITIES :
Conducts scheduling, and preregistration functions, validates patient demographic data, identifies and verifies medical benefits, accurate plan code and COB order.
Obtains limited clinical data based on service required. Corrects and updates all necessary data to assure timely, accurate bill submission. (20%)
Verifies insurance information through payor contacts via telephone, online resources, or electronic verification system.
Identifies payor authorization / referral requirements. Provides appropriate documentation and follow up to physician offices, case management department, and payors regarding authorization / referral deficiencies. (20%)
Identifies all patient financial responsibilities, calculates estimates, collects liabilities and post payment transactions as appropriate in the ADT system and performs daily reconciliation.
Identifies self-pay and complex liability calculations and escalates account to Financial Counselors as appropriate. (20%)
Delivers positive patient experience. Cooperates with and maintains excellent working relationships with patients, AHN leadership and staff, physician offices and designated external agencies or vendors.
Performs any written or verbal communication necessary to exchange information with designated contacts and promote working relationships. (10%)
- Maintains focus on attaining productivity standards, recommending innovative approaches for enhancing performance and productivity when appropriate. (10%)
- Adheres to AHN organizational policies and procedures for relevant location and job scope. Completes and / or attends mandatory training and education sessions within approved organizational guidelines and timeframes. (10%)
- Communicates team barriers, process flow or productivity issues to team lead. Assists team members with operational support and training.
Assists in resolving patient issues requiring additional oversight in a concise and informative manner as required. (10%)
Performs other duties as assigned or required.
QUALIFICATIONS : Minimum
Minimum
- High school diploma or GED; or one three months related experience and / or training; or equivalent combination of education and experience.
- Two previous years of related experience, preferably within a medical setting, financial services
setting, and / or a demanding customer service environment
Experience operating a PC and using software applications
Preferred
- Certification with Healthcare Financial Management Association or Certified Revenue Cycle Representative.
- Call / Service Center experience.
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 ()
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