Representative - Longstreet Clinic - Revenue Cycle

Northeast Georgia Health System•Gainesville, GA

About The Position

Under the supervision of the Patient Access Service Center Supervisor/Manager, this position is responsible for ensuring the delivery of outstanding customer service while scheduling, obtaining complete and accurate patient demographic information, identifying patient benefits and eligibility, obtaining pre-certification approvals from insurance companies and Physicians offices, identifying insurance and/or patient responsibility, collecting identified co-pay/deductible and/or providing financial counseling when appropriate, and completing the pre-registration process.

Requirements

High School Diploma or GED
Ability to work independently, emotionally mature, and able to function effectively under stress
Good communication skills
Excellent problem solving and analytical skills
Excellent written and oral communication skills
Ability to prioritize, organize, and coordinate daily work load
Working knowledge of Protected Health Information
Ability to manage change
Must possess detailed understanding and knowledge of insurance guideline and protocols, the components of full verification, and payor information / requirements

Nice To Haves

Two(2) years previous hospital registration/business office experience

Responsibilities

Responsible for data entry into scheduling system (for OR, Cardiology, and Radiology areas as assigned) including all information obtained from patient, Physician, and/or surgery staff. This data is including, but not limited to, correct procedures, diagnosis codes, and patient insurance information.
Responsible for identifying available times for scheduled procedures; ensures prompt scheduling to meet the convenience of patients, however, allows adequate time to complete insurance verification and authorization process as efficiently as possible without compromising the procedure.
Performs medical necessity checks on all appointments in which it is applicable; completes ABN notification upon any failure to meet medical necessity.
Obtains complete and accurate insurance information and completes insurance verification by contacting patients, Physician offices and insurance/payer regarding the visit; verifies patient’s insurance eligibility and benefits with the information obtained.
Works according to standard operating procedure during ADT/system downtimes.
Identify patient's history in all Patient Access Systems to avoid duplication of medical records.
Responsible for capturing and documenting all pertinent patient demographic, subscriber, and insurance information i.e.; patient policy and ID numbers, subscriber, guarantor, payor address, phone number, and contact information. Documentation must include, effective date, copay, deductible, out of pocket, co-insurance, percentage of coverage and any other pertinent information concerning the specific hospital visit into the ADT system.
Reviews work and assures accuracy in all aspects of the position; particularly, procedure scheduled, patient type, pavilion code, insurance information, and demographic information to minimize error rate and time delays in other areas.
As assigned, responsible for assuring all scheduled and non-scheduled inpatient and outpatient accounts are authorized either in advance or on the day of the service/admission date and within the time frames and guidelines set forth by the organization and payer; pre-certification is expected to be documented timely and appropriately.
Responsible for assessing financial responsibility for scheduled patients; communicates financial liabilities to patients prior to service date when applicable; collects pre-service payments; educates patients on billing process for the facility; refers patients for financial counseling if applicable.
Responsible for working with Physician offices and ancillary departments to ensure patient satisfaction is met in all aspects of their duties (including, but not limited to; scheduling, pre-registration, pre-certification).
Performs any and all related job duties as assigned; may have additional department specific duties assigned as deemed necessary by management.
Expected to answer, manage, and satisfy the customer during all incoming calls as appropriate to their specialty, and to meet department assigned goals relating to outbound calls, average speed to answer, max delays, AUX times, abandonment rate, and ACD time. In addition, expected to meet all customer service standards as set forth by management.
As assigned, expected to review accounts for order accuracy; responsible for contacting Physician offices with discrepancies or concerns regarding the scheduled appointment.
As assigned, responsible for indexing and labeling all faxed Physician orders timely and efficiently.
Understands and utilizes all systems appropriately as related to scheduling, pre-registration, insurance verification, estimations, electronic order system, pre-certification, and phone quality controls.
Expected to meet all goals set by department management to include, but not limited to; productivity, accuracy, collections, and customer satisfaction.