Admissions Counselor

Overview

The Patient Access Admissions Counselor is responsible for the verification and collection of patient demographic and insurance information by direct data entry to the electronic medical record during the scheduling/pre-admit or admission process prior to discharge. Performs verification of insurance benefits, documents current coverage and eligibility details, and completes timely notifications for required authorization of services. Ensures authorization for surgical/special interventional procedures and inpatient/observation hospital stays is secured with appropriate system documentation. Provides financial education and counseling to the patient related to insurance coverage, financial liability, and investigates avenues for alternate payer source or eligibility for financial assistance. Acts as an expert knowledge resource for clinical areas, Nursing Units or Care Management related to registration and financial counseling questions or issues.

Responsibilities

Patient Registration/Scheduling
* Demonstrates high degree of proficiency in computer skills and Microsoft applications; includes navigation of web-based or system applications required for Patient Access Services with keyboarding of 50+ wpm.

* Accurate identification of patient for direct data entry of required clinical, demographic, and insurance information to the electronic medical record during registration or for appointment booking of assigned procedures.

* Provides detailed explanation of scheduled procedures and patient instructions that are associated to the medical service.

* Ensures system documentation specific to the patient visit is entered and accurately reflects activities related to patient or provider contact, order documentation, insurance verification, financial education, and payment.

* Provides explanation of legal forms and secures signature of patient/authorized party as required for services.

* Performs medical necessity checking for identified services; secures required ABN documentation as appropriate.

* Demonstrates thorough understanding of compliance standards required within a healthcare environment including EMTALA and HIPAA-Privacy Patient Confidentiality regulations.

Insurance Verification for Eligibility/Authorization
* Accurate identification and selection of insurance carrier in the patient medical record for specified dates of medical services

* Navigates web-based products or system applications to initiate and document insurance eligibility, benefit details, authorization requirements.

* Performs required notifications to ensure insurance authorization for identified medical services, including surgical/special interventional procedures and inpatient/observation stays, are secured and documented.

* Demonstrates advanced knowledge of CPT, ICD10 coding, and physician order documentation as required for medical services including determinations for medical necessity.

Financial Counseling
* Demonstrates expert knowledge of regulatory or Third Party Payer insurance requirements including Medicare, AHCCCS/Medicaid, Workers Comp and other commercial payers.

* Educates the patient on insurance eligibility, coverage, procedure costs, alternate resources for financial assistance, and payment arrangement guidelines.

* Uses professional negotiation techniques to collect identified patient financial liabilities; performs secured payment entry and deposit/cash reconciliation steps.

* Navigates web based products to initiate, document, and provide charge estimation for Inpatient/Observation stays, Surgical/Special Interventional procedures or service categories based on patient requests or financial counseling needs.

* Demonstrates advanced conflict resolution skills to address issues related to scheduling, registration or the financial assistance application approval process.

* Makes direct contact on behalf of the patient to providers, insurance representatives, or outside agencies such as Arizona Department of Economic Security to initiate and monitor success of AHCCCS application process.

* Monitors system work lists to provide necessary financial counseling follow-up for private pay patients in the Emergency Department and Inpatient/Observation settings. Ensures patient account is updated to reflect new payer source(s).

Revenue Cycle Support for Hospital or Clinical Services
* Handles department call volumes as assigned to appropriately respond to requests from patients, providers, or other hospital departments.

* Acts as an expert resource to clinical departments for registration/scheduled services related to data entry of patient account fields, provider order requirements, and questions regarding insurance coverage or financial assistance.

* Coordinates information with Nursing Units or Care Management related to registration, financial counseling, or insurance coverage and benefit limits affecting patient length of stay and discharge planning efforts.

* Monitors and analyzes Revenue Cycle reports and system work lists to ensure accuracy of patient record and that all process steps, insurance requirements, and compliance standards have been met for scheduling, registration, and financial counseling activities.

Compliance/Safety
* Responsible for reporting any safety-related incident in a timely fashion through the Midas/RDE tool; attends all safety-related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.

* Stays current and complies with state and federal regulations/statutes and company policies that impact the employee's area of responsibility.

* If required for the position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates.

* Completes all company mandatory modules and required job-specific training in the specified time frame.

Qualifications

Education

High School Diploma or GED- Required

Associate's Degree- Preferred

Certification & Licensures

Experience
2 years in a customer service role- Required

Proficiency in Microsoft applications (Excel, Word, PowerPoint)- Required

3 - 5 years experience in a medical facility, health insurance, or related medical field- Preferred

Medical Terminology course work- Preferred

Healthcare is a rapidly changing environment and technology is integrated into almost all aspects of patient care. Computers and other electronic devices are utilized across the organization and throughout each department. Colleagues must have an understanding of computers, and competence in using computers and basic software programs.