Central Access Precertification Representative

3 weeks ago

Chattanooga, United States Medicine Journal Full time

Job Summary:
The Central Access Precert Rep is responsible for scheduling, securing patient demographic and insurance information; verifying insurance eligibility and benefits, obtaining and securing pre-certification and clinical documentation obtained and validated. Strong emphasis of managing scheduled cases less than 24 hours and same day add-on cases. Position demonstrates ability to interpret Local Coverage Determination and National Coverage Determinations or commercial contract requirements necessary for pre-certification or authorization. Central access specialist III manages heavy call and schedule volumes. Position is responsible for notifying patients of their financial obligation and collecting co-pays, deductibles, deposits and other identified out-of-pocket liabilities or deposits on accounts as required and supporting their department in meeting the pre-collections goals defined by Revenue Cycle management. This also includes a review of past account balances, notifying patient of additional financial responsibility, and attempt collection of these balances. Review accounts with inadequate financial coverage for the purpose of coordinating with the Central Access Financial Advocate. Position will have daily interactions with physicians or their office designee and with Erlanger's clinical department leaders as necessary to financially clear the patient for the next day of service. The Central Access Precert Rep demonstrates professionalism as reflected by courteous actions, maintenance of confidentiality and appropriate presentation of self; consistently exhibits excellent oral and written communication skills; possess the knowledge and skills necessary to provide interactive communications appropriate to the age of the patient being served; interact appropriately with third party payers and other departments; and have the ability to relate well to people of a broad socio-economic mix. Strong organizational skills, ability to multitask, work in a fast pace environment, manage a multi-line phone system and a commitment to teamwork are essential. Must have ability to work closely in a clinical setting involving some stressful situations.

Education:
Required:
High School or Equivalent

Preferred:
Associate's Degree in Business Administration or healthcare related field

Experience:
Required:
Three years work experience in either a governmental or commercial insurance provider office with call center experience or two years experience as a Central Access Specialist I or as an Pt Access Specialist II with proven work outcomes and no current disciplinary actions within the past year. Strong Medical terminology, and moderate knowledge of CPT and ICD-9 codes, insurance coding and billing knowledge, Ability to read, write and arithmetic including fractions and decimals. Strong computer skills, excellent customer service skills and interpersonal communication and telephone etiquette are required. Exhibit comprehension of scheduling, registration, financial clearance and physician order processes. Ability to interpret health insurance benefits, clinical documentation from physician office to secure medical necessity. Computer, fax machine, copier, multiline telephone. Demonstrate ability to multitask and manage high volumes. Individual is a self-starter and demonstrated ability prioritize work and manage multiple task in a sometimes stressful environment.

Preferred;
Bilingual

Position Requirement(s): License/Certification/Registration
Required:

Preferred:
Certified Healthcare Access Associate from NAHAM

Essential Functions:
1. Answering incoming phone calls and scheduling outpatient
appointments.

2. Pre-register scheduled patients by gathering all patient demographic
and financial information.

3. Verify insurance eligibility and benefits for scheduled outpatient and
inpatient patients.

4. Validate and initiate pre-certification.

5. Compute patient liability.

6. Communicate and initiate time of service collections.

7. Review prior bad debts and request payment of outstanding prior bad
debt.

8. Alert Financial Advocates of accounts with financial clearance issues.
Document patient liability and financial clearance status to ensure
timely processing at the point of service.

9. Complete pre-registration, insurance verification and financial
clearance for special admission and transfer patients.

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