Patient Access Insurance Verification Rep
Serves as first point of contact for customers of TMC HealthCare; initiates the entry point for requested healthcare services and revenue management. Responsible for computerized patient registration and scheduling as well as insurance verification to include validation of authorizations and/or benefits information for ancillary procedures. Maintains and fosters effective public relations with patients and visitors.
; adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.
Collects deposits or deductibles and advises patient or guarantor of insurance benefits and anticipated cost estimates; ensures that cash handling follows corporate policies.
Ensures completion of financial documentation in accordance with TMCH’s credit and collection policies.
Explains all necessary compliance forms and obtains patient signature as required for regulatory agencies.
Performs medical necessity screening and ensures compliance with system requirements.
Assists outpatient departments with minor system maintenance, to include closing resources, opening resources, performing overbook and override as requested.
Interacts with physicians and/or physicians’ office staff to secure diagnosis, procedure details or authorization information as needed.
Communicates with Medical Records and Professional Staff Services as necessary.
Uses medical terminology and scheduling knowledge to select correct procedure when scheduling and coordinates information with other departments as needed.
Demonstrates knowledge of resources, staffing, instrumentation, and equipment specific to procedures to avoid scheduling conflicts.
Performs patient registration activities to ensure accurate financial and biographical data and documentation have been obtained and properly entered into hospital records.
Completes insurance processing; including account creation, insurance verification, notification, and authorization functions
Communicates with departments/physicians for special requests, emergent cases, overbooking and add-ons; informs management about issues/problems with tools/times.
Handles incoming telephone calls and exercises judgment in scheduling caller for correct procedure in appropriate service area; receives telephone requests to schedule from patients, physicians, physician office staff, employers, and hospital personnel, if applicable.
Explains procedure preparations to patients so they are properly prepared before arriving at the hospital as needed.
Documents all notification, authorization and eligibility information in the registration systems, uses electronic verification tools and web-based resources.
Adheres to TMCH organizational and department-specific safety, confidentiality, values policies and standards.
Reconciles daily cash drawer.
May prepare and reconcile daily deposits.
Performs related duties as assigned.
EDUCATION: High School diploma or General Education Degree (GED), completion of vocational medical office training desired, or an equivalent combination of relevant education and experience.
EXPERIENCE: Two (2) years of medical office and/or hospital experience to include six months healthcare eligibility and benefit analysis or scheduling experience for diagnostic testing and/or surgery.
LICENSURE OR CERTIFICATION: Heartsaver CPR (HSCPR or HSFACPR) certification required within ninety (90) days of employment for Pediatric Therapies department only.
KNOWLEDGE, SKILLS AND ABILITIES:
Knowledge of office management practices, including billing and scheduling within healthcare.
Ability to read or listen and comprehend simple instructions, short correspondence, and memos.
Ability to write simple correspondence; ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
Ability to read and interpret documents such as safety rules, procedure manuals, and governmental regulations.
Ability to effectively present information and respond to inquiries or complaints from patients and/or their representatives and the general public.
Ability to interpret and explain insurance benefits and patient financial responsibility.
Ability to apply common sense understanding to carry out simple/detailed written or oral instructions.
Applicants must have basic computer familiarity and experience and the ability to operate basic office equipment.