Patient Access Rep III

CHI; Normangee (TX); On-site; USD 35,000 - 45,000; Full time

Job summary

A leading healthcare provider in Texas seeks a dedicated professional to assist with hospital services access, ensuring accurate patient eligibility verification and pre-certifications. The role involves guiding patients through financial matters and coordinating with insurance payers to enhance customer satisfaction and reimbursement accuracy. Candidates should possess extensive knowledge of various insurance plans and regulations, along with a high school diploma and two years of relevant experience.

Qualifications

• Two years of related experience required.
• Extended knowledge of insurance payers and hospital contracts.

Responsibilities

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

Skills

Knowledge of HMO’s

Knowledge of PPO’s

Knowledge of HIPAA

Knowledge of EMTALA regulations

Education

High School Diploma/GED

Job description

Responsibilities

Assist in providing access to hospital services. Knowledge of tasks in the Verification/Pre-certification area is necessary to ensure customer satisfaction and accurate reimbursement. The primary function is verifying patient eligibility and benefits, obtaining pre-certifications, 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 and ensure accurate information exchange for efficient 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, physicians, 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. Work with patients and families to address insurance coverage gaps through alternative funding options.
9. Resolve patient billing issues.
10. Ensure accurate listing of payers, including primary, secondary, and tertiary coverage.
11. Process patient accounts and resolve insurance issues per policies.
12. Initiate pre-certification for in-house patients, obtaining reference numbers and contact details.
13. Notify hospital Case Managers of insurance plan changes and pre-certification requirements for in-house patients.
14. Contact physicians regarding authorization requirements and financial holds for scheduled patients.
15. Analyze reports for accurate admission dates and patient type changes.
16. Maintain updated reference materials on insurance companies and pre-certification requirements.
17. May serve as team lead to ensure smooth daily operations, including coverage, scheduling, and quality assurance.

Qualifications

Education and Licensure

Required: High School Diploma/GED

Minimum Experience

Two (2) years of related experience

Knowledge, Skills, and Abilities

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