Patient Access Representative III
4 weeks ago
We are seeking a highly skilled Patient Access Representative III to join our team at Chi. This role is responsible for providing exceptional patient access and eligibility services, ensuring seamless communication with patients, families, and healthcare providers.
Key Responsibilities
• Obtain detailed patient insurance benefit information and discuss benefits and financial issues with patients and/or family members during initial evaluation.
• Advise patients on insurance and billing issues and options, serving as a resource for patients and their family members on financial matters.
• Coordinate all necessary payer authorizations and consistently monitor and update information regarding insurance data, physicians, authorizations, and managed care contracting.
• Assist patients and their families with questions concerning insurance and other financial issues, identifying and effectively communicating financial information to team members, patients, and their families.
• Work with patients, their families, and team members to help address insurance coverage gaps via alternative funding options and facilitate resolution of patient billing issues.
• Ensure payers are listed accurately, pertaining to primary, secondary, and/or tertiary coverage and billing when a patient has multiple third-party/governmental payers listed on an account.
• Process patient accounts and deploy established policies to resolve insurance issues with patient accounts.
• Initiate precert for in-house patients when required, obtaining precertification reference number, approved length of stay, and utilization review company contact person and telephone number.
• Notify hospital Case Managers on all in-house patients regarding insurance plan changes/COB order, out-of-network plans, and Medicare supplemental plans that require precertification.
• Contact physicians on scheduled patients to notify them of authorization requirements and any possible financial holds.
• Analyze reports to ensure admission dates for patient type changes are accurate in order for the account to appear on insurance verification reports.
• Maintain and update reference notebooks on insurance companies, employers, precertification requirements, etc., to stay current on changes within the insurance industry.
• May function as team lead to ensure smooth operation of daily activities, including assisting with coverage, scheduling, providing feedback, and quality assurance.
Qualifications
• High School Diploma/GED
• Two (2) years of related experience
• Extended knowledge of HMOs, PPOs, Commercial/Governmental payers, and System/Entity specific hospital contracts with Third Party payers.
• Extended knowledge of HIPAA and EMTALA.
Disclosure Summary
The job summary and responsibilities listed above are designed to indicate the general nature of the work performed within this job. They are not designed to contain or be interpreted as a comprehensive inventory of all job responsibilities required of employees assigned to this job. Employees may be required to perform other duties as assigned.
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