Patient Access Representative

2 weeks ago

Laurel, Montana, United States Virtua, Inc. Full time

Summary:

Responsible for scheduling elective cases in scheduling systems accurately and completely to support operations' needs.


Responsible to ensure the completion of insurance verification, pre-certification, first party payment arrangements, pre-registration and point of service collection for all pre-scheduled inpatient, surgical, and high dollar outpatient scheduled cases via scheduling systems.

Provide assistance to customer on financial counseling, price estimation on services and out of pocket costs.


Verifying all insurance is correct in both the Patient Management and Patient Accounting systems to ensure an expedited registration process at the date of service and the production of a clean bill within the time frames set up by Virtua financial policies and regulatory guidelines to support the revenue cycle.

Daily duties are performed to optimize the customer experience and provide an outstanding customer experience with every customer encounter.

Position Responsibilities:

  • Schedule elective cases in applicable scheduling system accurately and completely per established process flows and standard operation procedures to support operations scheduling needs.
  • Process all registrations accurately and timely for scheduled cases to ensure a clean bill which includes the following but is not limited to:
  • Accurately verifying and completing patient eligibility and insurance verification utilizing 3rd party sponsorship via phone and electronically which includes HDX, Navinet, Payor Sites etc.) in accordance with department policies and procedures.
  • Ensure CPTs are accurate for scheduled service, correct case status, validate and obtain proper precertification and referral is in place to ensure reimbursement.
  • Ensures coordination of benefits with multiple insurance payors.
  • Contacts physicians, their office staff and patient to obtain necessary information to complete pre-certification process.
  • Provides patients, physician offices, facility departments, and patient access campus registrars with explanation of insurance benefits, limitations and authorization guidelines.
  • Identifies and provides appropriate referrals and payment options to patients needed financial assistance and provides pricing to customers on Virtua services.
  • Completes full pre-registration per department policies and procedures in Patient Management system via phone with patient to expedite check-in at the date of service and to optimize the Virtua Customer Experience.
  • Correctly identifies, collects and processes co-pays, deductibles, co-insurance and deposits from patients and may facilitate resolution of billing issues by liaising with patient accounting, patient, and insurance representative with the ability to provide payment arrangements.
  • Understands and follows all patient access compliance and regulatory requirements for State, Federal which includes CMS.
  • Special projects and duties as determined by manager / supervisor to support the goals and objectives of the department.
Position Qualifications Required /

Experience Required:

3-year minimum medical office or medical admittance experience preferably in a surgical or specialist office with an excellent understanding of third-party reimbursement and methodologies for all third-party payers especially pre-certification and COB regulations required.


One year of Epic experience highly preferred o r 3 years minimum at Virtua Patient Access department as a registrar who has demonstrated outstanding registration skills with strong insurance knowledge, and COB regulations.

Must demonstrate a positive demeanor, have both strong verbal and written communication skills.

Must be able to handle potentially stressful situations and multiple tasks.

Must have basic typing, computer and/or word processing skills.

Required Education:

High School diploma.


Virtua welcomes all individuals, inclusive of race, sex, sexual orientation, gender identity, religion and faith, national origin, and disabilities, and we proudly look to each person's unique achievements and experiences to continue to set us apart.

Our whole-hearted commitment to an inclusive, diverse, and equitable workplace enables Virtua to be here for our communities, here for our patients, here for our colleagues-Here for Good.

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