This position conducts insurance eligibility and benefit coverage details. Point of service collections and obtains authorizations and forms needed to maximize reimbursement. Document all facets of the registration process and meet accuracy goals as determined by management. Perform effective financial counseling. Calculate out of pocket responsibility and collect payments and meet regular collection targets as determined by management. Demonstrates the ability to identify and resolve coverage and reimbursement delays. Assist in COBRA, coverage and/or financial assistance applications.  Resolve customer issues and provide excellent customer service. Third party payor collections.

 

Essential Functions

Performs pre-registration/registration processes, verifies eligibility and obtains benefit details, submits notifications and verifies authorizations for services. Verifies patient and guarantor demographics and accurately inputs this information into patient accounting software systems, including documenting the account thoroughly in order to maximize reimbursement and minimize denials/penalties from the payor(s). Obtains federally/state required information and all consents and documentation required by the patients’ insurance plan(s). Must be able to consistently meet monthly individual accuracy goal as determine by management.

Verifies and understands insurance benefits. Estimates and collections of guarantor cost at the time of service or during the pre-registration process. As assigned, collection attempts may be made at the bedside. Must be able to consistently meet monthly individual collection target as determined by management.

Provide financial counseling to the patient’s guarantor and family. Explains company financial policies and provides information as to available resources. Assists patients with applying for coverage.  Assists patients with completing all financial assistance programs (i.e.: basic financial assistance, enhanced financial assistance, prompt pay discount, loan program).

Acts as a liaison between the guarantor/patient, the billing department, vendors, physician offices and the payor to enhance account receivables performance and meet payment collection goals, resolve outstanding issues and/or patient concerns and maximize service excellence. Communicates with Direct Manager and the Administration, Intake, Utilization Management, Physicians, Clinical, and Health Information Departments and staff to resolve outstanding issues and/or patient concerns and to meet the guarantor/patients’ needs in financial services.

Consistently meets monthly individual productivity goal as determined by management. Completes daily assignments/work lists, keeps electronic productivity log up to date and inputs information accurately. Identifies opportunities to improve process and practices good teamwork.

Provides a variety of patient services and financial services tasks. Maintain productivity standards as determined by Management, performing third party payor collection efforts, initiating appeals and tracking determinations.  Conducting other work assignments of the Business Office team.

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