Patient Access Insurance Verification Rep
Contacts insurance payors to secure eligibility, benefits and authorizations for services rendered to ensure financial reimbursement for the facility.
ESSENTIAL FUNCTIONS :
Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors and staff ; adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication.
Obtains co-pay, co-insurance, deductibles and out of pocket maximum for patient and/or guarantor for anticipated services and admissions.
Ensures completion of financial documentation in accordance with TMCH’s credit and collection policies.
Interacts with physicians and/or physicians’ office staff to secure diagnosis, procedure details or authorization information.
Performs patient registration activities to ensure accurate financial and biographical data and documentation have been obtained and properly entered into hospital records, as applicable.
Completes insurance processing; including account creation, insurance verification, notification, and authorization functions.
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.
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 : Preferred one (1) year of medical office and/or hospital experience to include healthcare eligibility and benefit analysis or scheduling experience for diagnostic testing and/or surgery.
LICENSURE OR CERTIFICATION : None required.
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 a bility to operate basic office equipment.
PHYSICAL DEMANDS AND WORK ENVIRONMENT :
The physical demands and work environment described here are representative of that which an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands and fingers to handle or feel; and talk or hear. Frequently required to stand; walk; reach with hands and arms; and stoop, kneel, or crouch; frequently lift and/or move up to 25 pounds without assistance. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
While performing the duties of this job, the employee may potentially be exposed to infectious organisms during routine and emergency situations. T he employee will work in a fast paced and demanding work environment. The noise level in the work environment is usually moderate.