Patient Access Rep III

CommonSpirit Health; College Station (TX); On-site; USD 35,000 - 55,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated individual to assist with insurance verification and financial counseling. In this role, you will ensure accurate information exchange to facilitate efficient account processing and enhance patient satisfaction. You will play a crucial part in guiding patients through their insurance benefits while maintaining compliance with regulations. Join a mission-driven organization committed to building healthy communities and advocating for those in need, where your contributions will make a significant impact on patient care and financial clarity.

Qualifications

• 2+ years of experience in insurance verification and financial counseling.
• Strong knowledge of HMO’s, PPO’s, and government payers.

Responsibilities

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

Skills

Insurance Verification

Customer Service

Financial Counseling

Knowledge of HIPAA

Knowledge of EMTALA

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 necessary to ensure customer satisfaction and accurate reimbursement. The primary function is verifying eligibility/benefits, obtaining pre-authorization, and notifying third-party payers within contractual compliance, 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 to facilitate efficient account processing.

1. Obtain detailed patient insurance benefit information.
2. Discuss benefits and financial issues with patients and families during initial evaluation.
3. Advise patients on insurance and billing 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 with questions regarding insurance and financial issues.
7. Communicate potential patient out-of-pocket liabilities effectively.
8. Address insurance coverage gaps via alternative funding options with patients and families.
9. Resolve patient billing issues.
10. Ensure accurate listing of payers, including primary, secondary, and tertiary coverages.
11. Process patient accounts and resolve insurance issues according to policies.
12. Initiate pre-certification for in-house patients, obtaining necessary references and approvals.
13. Notify hospital Case Managers of insurance plan changes, COB, out-of-network plans, and Medicare supplemental plans requiring pre-certification.
14. Notify physicians of authorization requirements and financial holds for scheduled patients.
15. Analyze reports for admission date accuracy related to patient type changes.
16. Maintain current reference materials on insurance companies, employers, and pre-certification requirements.
17. May serve as team lead to ensure smooth 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.

Extended knowledge of HIPAA and EMTALA regulations.

Overview

CommonSpirit Health was formed by 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 services, CommonSpirit is accessible to nearly one in four Americans. Our mission is to build healthy communities, advocate for the poor and vulnerable, and innovate healthcare delivery inside and outside hospitals.