Patient Service Representative Hospital-PRN

Overview

13512 Enterprise Revenue Cycle - Floyd Chattooga GA Arrival Emergency Department

Status:
Part time

Benefits Eligible:
No

Hours Per Week: 0

Schedule Details/Additional Information:
Various/PRN

Pay Range: $20.80 - $31.20

Major Responsibilities:

• Responsible for performing all job duties in a way that conforms to our customer service philosophy and consistent with our "AIDET" standards
• When creating new registrations for walk-in patients, responsible for the identifying insurance coverage, the benefits available, patient out-of-pocket expenses, and collecting co-insurance and co-payments.
• Uses electronic systems to confirm coverage while patient is present and discussing the findings with the patient. Follow established department policies to resolve issues related to patient s eligibility for coverage or issues in in-network status for the patient using Advocate s network.
• When working uninsured patients, screen for urgent status cases and follow charity procedure. Refer as appropriate for additional financial counseling. Engage leaders to resolve questions on urgent versus non-urgent/elective care.
• When assisting walk-in patients, screen orders for compliance with policy. Work with physicians, Care Coordinators, and clinical department leaders to communicate and resolve issues related to order quality and acceptable standards.
• Responsible for security authorization and precertification of inpatient and outpatient services.
• Notify Financial Counseling, physicians, Care Coordinators, and Utilization Management on cases where patients are uninsured, or where the only insurance is Third Party Liability or Workers Compensation
• Maintains knowledge of all stand-alone computer software programs to verify eligibility.
• Identify at risk balances related to Medicare co-days, lifetime reserve days and other Medicare coverage limits and communicate to Financial Counseling, UM and physicians
• Identify at risk balances related to Medicaid eligibility rules and communicate to Financial Counseling, UM and physicians
• Initiates communication to patient when authorization is not obtained and explain the potential financial impact and the patient responsibility for unauthorized services
• Accurately collects and analyzes clinical data in support of prior authorization, and precertification as required by payor guidelines
• Acquires and maintains current knowledge of all insurance requirements as it relates to patient/hospital responsibility and hospital billing.
• Stays current of all Federal and State regulations regarding billing.
• Ensures completion of all established policies and procedures for identification and notification of the Primary Care Physician in the case of HMO coverage plans.
• Informs Financial counseling, physicians, Care Coordinators and Utilization Management of out of network or noncovered service limitations of managed care/commercial insurance where benefits are at risk

• Responsible the pre-registration and registration accuracy.
• Maintains knowledge of State & Federal regulations governing Medicare, Medicaid and Mental Health registrations.
• Ensure accurate entry of patient demographic, insurance information in the ADT system with special attention to carrier code assignment, complete benefit, eligibility record and authorization data
• Pre-registers and registers patients using established procedures for computer entry for all ancillary and nursing units, keeping current with their specialized needs and preparing necessary documents/records when necessary.
• During the pre-registration or registration encounter, provide detailed education to the patient the contents of documents and forms requiring patient signature.
• Manage incoming and outgoing calls in order to complete pre-registrations with patients
• Generates, assembles and processes all required documents for completion of each registration.

• Participates in departmental team building activities and in-services and other miscellaneous duties as assigned by leader.
• Contributes to the quality initiatives and mission by participating in team projects.
• Attends all required departmental in-services to stay current of all job changes and responsibilities.
• Assist leader in…