Patient Access Rep III

CHI; College Station (TX); On-site; USD 40,000 - 80,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated professional to assist with insurance verification and patient financial services. This role is crucial in ensuring customer satisfaction by verifying patient eligibility, obtaining necessary authorizations, and guiding patients through their insurance options. With a commitment to building healthy communities, the organization offers a dynamic work environment where your contributions directly impact patient care and financial processes. If you are passionate about helping others navigate their healthcare journey and have a keen understanding of insurance protocols, this opportunity could be perfect for you.

Qualifications

• Two years of experience in insurance verification and financial counseling.
• Knowledge of HIPAA and EMTALA regulations is essential.

Responsibilities

• Verify patient eligibility and benefits for insurance coverage.
• Assist patients with financial issues and insurance inquiries.
• Coordinate necessary payer authorizations and monitor insurance data.

Skills

Insurance Verification

Patient Eligibility Verification

Customer Service

Knowledge of HMO’s and PPO’s

Financial Counseling

Education

High School Diploma/GED

Job description

Responsibilities

Assist in providing access to services at the hospital. Knowledge of tasks in the Verification/Pre-certification area is essential to ensure customer satisfaction and accurate reimbursement. The primary function involves verifying patient eligibility/benefits, obtaining pre-certifications or authorizations, and notifying third-party payers in compliance with contractual agreements with high accuracy. Participate in upfront collections by informing patients of estimated out-of-pocket costs during insurance verification. Establish the hospital’s financial expectations for patients and ensure accurate information exchange for efficient account processing.

1. Obtain detailed patient insurance benefit information.
2. Discuss benefits and financial issues with patients and/or family members during initial evaluation.
3. Advise patients on insurance and billing issues and options, serving as a resource for financial matters.
4. Coordinate necessary payer authorizations.
5. Monitor and update insurance data, physician information, authorizations, and managed care contracts.
6. Assist patients and families with questions regarding insurance and financial issues.
7. Communicate potential patient out-of-pocket liabilities effectively.
8. Help address insurance coverage gaps via alternative funding options when possible.
9. Resolve patient billing issues.
10. Ensure accurate listing of payers, including primary, secondary, and tertiary coverage, especially for patients with multiple payers.
11. Process patient accounts and resolve insurance issues following established policies.
12. Initiate pre-certification for in-house patients, obtaining reference numbers, approved stay lengths, and contact information for utilization review.
13. Notify hospital case managers of insurance plan changes, COB orders, out-of-network plans, and Medicare supplemental plans requiring pre-certification.
14. Contact physicians to notify them of authorization requirements and financial holds for scheduled patients.
15. Analyze reports to verify accurate admission dates for patient type changes to ensure proper insurance verification.
16. Maintain and update reference materials on insurance companies, employers, and pre-certification requirements.
17. Potentially serve as team lead to oversee daily operations, including coverage, scheduling, feedback, and quality assurance.

Qualifications

Education and Licensure

Required: High School Diploma/GED.

Minimum Experience

Two (2) years of related experience.

Minimum Knowledge, Skills, and Abilities

Extended knowledge of HMO’s, PPO’s, Commercial/Governmental payers, and hospital contracts with third-party payers. Knowledge of HIPAA and EMTALA regulations.

Overview

CommonSpirit Health was formed through the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With over 700 care sites across the U.S., including clinics, hospitals, home-based, and virtual care, CommonSpirit is accessible to nearly one in four U.S. residents. Our mission is to build healthy communities, advocate for the poor and vulnerable, and innovate healthcare delivery inside and outside hospitals.