Patient Access Insurance Verification Representative Lead - TMCH Cancer Center

SUMMARY:

Assists manager with review and assignment of work to staff responsible for timely and accurate registration to include eligibility, benefits and authorizations for services rendered to ensure financial reimbursement for the facility.  Performs audits and provides necessary training for scheduling staff.  Recommends and coordinates performance improvement initiatives under the direction of the manager/supervisor.  Actively provides excellent customer service by serving as the initial patient point of contact for TMC HealthCare and the Business office; facilitates access to the medical center services through use of computer-based scheduling system or telephonic communication.  Processes upcoming visits as scheduled, creating new patient accounts as required, contacts insurance payers to secure authorizations for services as required and/or assists patients with enrollments with foundation/grants or free drug programs for oncology services.

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. 

Collects deposits or deductibles as required and advises patient or guarantor of insurance benefits and anticipated cost estimates; ensures cash handling follows corporate policies.

Ensures completion of financial documentation in accordance with TMCH’s credit and collection policies.

Assist patients with enrollment in foundation, grant and/or free drug programs to enable access to services and continuity of care with oncology services.

Explains all necessary compliance forms and obtains patient signature as required for regulatory agencies.

Interacts with physicians and physician’s 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. 

Completes insurance processing, including account creation, insurance verification, notification, and authorization functions.

Updates and distributes information regarding patient demographics including insurance information.

Obtains required information from patients, other departments and physicians, as needed; communicates with patients or designated other parties regarding financial responsibility and collects payment for the same, if applicable.

Supports quality improvement initiatives through team participation, process change implementations and other activities.

Communicates and interfaces with hospital personnel, patients, medical staff, and family members to ensure high-quality patient care.  Established as point of contact for internal department personnel as a resource to guide and assist with complex scheduling and/or emergency cases.

Updates, compiles, and distributes information regarding patient demographics including insurance information.

Documents all notification, authorization, and eligibility information in the registration systems, uses electronic verification tools and web-based resources.

Contacts insurance carriers by telephone for appropriate billing information such as authorization numbers, eligibility, and benefits; documents all activity and additional information received in scheduling system.

Uses existing or new software to facilitate reconciliation of orders received to facilitate follow up for incomplete orders, authorizations, and missing scripts via order images for electronically submitted orders to compliance and billing issues prior to patient appointments.

Establishes positive relationships with ancillary departments and specialty physician referring offices as a main point of contact.

Maintains appropriate filing systems, records, reports, and confidential files to ensure quick retrieval of information.

May prepare daily deposit and reconcile daily batch.

Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards.

Performs related duties as assigned.

MINIMUM QUALIFICATIONS:

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 (3) 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 ability to operate basic office equipment.