Patient Access Rep III

CommonSpirit Health; Normangee (TX); On-site; USD 35,000 - 60,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated professional to assist patients with insurance verification and financial matters. In this vital role, you will ensure accurate reimbursement and customer satisfaction by verifying eligibility, obtaining pre-certifications, and advising patients on their insurance options. Your expertise in navigating complex insurance systems will be essential in facilitating smooth operations and enhancing patient experiences. Join a team that values accuracy and compassion in healthcare delivery, and make a meaningful impact on patients' financial journeys.

Qualifications

• 2+ years of experience in insurance verification and patient financial services.
• Strong understanding of HMO, PPO, and hospital contracts.

Responsibilities

• Verify patient eligibility and benefits for insurance coverage.
• Assist patients with financial issues and insurance questions.
• Coordinate payer authorizations and pre-certifications.

Skills

Insurance Verification

Patient Communication

Financial Counseling

Knowledge of HMO/PPO

HIPAA Compliance

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 essential to ensure customer satisfaction and accurate reimbursement. The core function involves verifying eligibility/benefits, obtaining pre-certifications/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 and ensure accurate information exchange to facilitate efficient processing for both the hospital and patients.

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, billing issues, and options, serving as a resource for financial matters.
4. Coordinate necessary payer authorizations.
5. Monitor and update insurance data, physicians, authorizations, and managed care contracting information.
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.
9. Resolve patient billing issues.
10. Accurately list payers for primary, secondary, and tertiary coverages when applicable.
11. Process patient accounts and resolve insurance issues according to established policies.
12. Initiate pre-certifications for in-house patients, obtaining reference numbers, approved stay durations, and contact details for utilization review.
13. Notify hospital Case Managers about insurance plan changes, COB, out-of-network plans, and Medicare supplements requiring pre-certification.
14. Inform physicians of authorization requirements and financial holds for scheduled patients.
15. Analyze reports for accurate admission dates and patient type changes for insurance verification.
16. Maintain and update reference materials on insurance companies, employers, and pre-certification requirements.
17. May serve as team lead to ensure smooth daily operations, assist with coverage, scheduling, provide feedback, and oversee 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/Governmental payers, and hospital contracts with third-party payers.

Extended knowledge of HIPAA and EMTALA regulations.