Job Description

Essential Job Functions

• Receives and greets patients courteously and pleasantly upon arrival.
• Interviews patients by telephone or in person to collect demographic, guarantor, insurance, and financial data required for billing.
• Mails or telephones appointment reminders to patients.
• Verifies insurance coverage and admission dates; explains facility policies, payment responsibilities, and credit policies.
• Financially counsels patients and families, collecting or arranging payment at the time of preadmission or registration. Documents all account activity to ensure proper billing.
• Identifies patients unable to meet complexity/payer mix requirements; assists in identifying community resources for follow-up care matching their clinical needs and personal priorities.
• Handles all pre- and post-billing inquiry functions; responds to written correspondence and directly with patients regarding inquiries, resolves patient charge disputes, and processes patient refunds.
• Identifies adjustments/discounts on claims, initiates resolution of accounts placed with collection agencies, and collects or arranges financial arrangements for patient balances.
• Initiates the pre-admission insurance verification process by obtaining basic insurance information from the patient; contacts insurance carriers to obtain reference numbers and notifies patients of insurance acceptance.
• Obtains authorization from managed care companies to cover outpatient services. Secures pre-certifications as required by the plan. Works with the managed care office to identify and interpret contracts governing patient care.
• Collects referrals from patients, enters information into the electronic health record system, and forwards originals to billing for appropriate recording.
• Prepares various correspondence and reports, clinic consultation notes, referral letters, and other departmental correspondence. Maintains appropriate files of all correspondence.
• Initiates problem solving to resolve patient questions/complaints and refers escalated concerns to appropriate sources for resolution.
• Performs other duties as assigned.

Qualifications

• High school diploma or equivalent with five years of related work experience required. Bachelor's degree preferred.
• At least two years of experience in hospital patient accounting processes and hospital information systems, or related work experience.
• Knowledge of scheduling templates, insurance verification, third-party collection procedures, and responding to insurance and related companies on behalf of the patient.
• Knowledge of hospital billing and collection processes.
• Excellent writing, verbal communication, organizational, and customer service skills.
• Ability to work effectively on multiple tasks simultaneously, work independently, use discretion and good judgment, and handle confidential information appropriately.
• Ability to type 35 words per minute.
• Proficient in Microsoft Office products and applicable systems.