Process - Maintains the best practice routine per department guidelines. Daily work queues are maintained at acceptable levels according to department policies. Correspondence worked daily to current.
Registration - Performs financial clearance process by interviewing patients and collecting and recording all necessary information for pre-registration and registration of patients. Ensures that proper insurance payer plan choice and billing address are assigned in the automated patient accounting system. Verifies relevant group/ID numbers.
Completes the registration process according to established policies and procedures.
Ensures patient receives necessary disclosures, privacy information, and signs the relevant documentation.
Financial Clearance - Contacts payers to verify insurance eligibility. Completes automated insurance eligibility verification, when applicable, and appropriately documents information in the patient accounting system. Determines the patient’s insurance type and educates patients regarding coverage and/or coverage issues.
Informs families with inadequate insurance coverage regarding financial assistance through government and financial assistance programs. Performs initial financial screening and refers accounts for financial counseling and/or appropriate eligibility assessments.
Ensures all referrals and treatment authorizations for all patient types have been obtained according to the outlined requirements. If not obtained, contact payers for approvals.
Completes initial medical necessity checks. Refers to designated area if medical necessity fails or if referrals /authorizations are denied.
Responsible for obtaining complete and accurate demographic, financial, and clinical information to help ensure maximum reinbursement for the hospital.
Pre-Service / Point of Service Collection - Interprets third party payer policies to establish patient financial liabilities and work with patients so they understand their patient financial responsibilities.
Collect co-payments, co-insurance, and deductibles according to pre-service/ point of service collections policies and procedures.
Communication & Miscellaneous - Advises next-level leader of possible postponement or deferrals of any elective/non-emergent admission which has not been approved prior to service date. Maintains accurate files for pre-processing information as required.
Investigates, resolves, and documents patient problems in a timely and efficient manner. Maintains accurate files for pre-processing information.
Investigates, resolves, and documents patient problems and contact medical staff, nursing staff, ancillary departments, and administration as necessary.
Assists with cross training function in areas within Patient Access Services.
Performs related responsibilities as required or directed.
High School Graduate, or equivalent
LICENSURE, REGISTRATION, CERTIFICATION:
1-2 years health care or related experience preferred