Job Description: GENERAL DESCRIPTION Under close supervision verify patient insurance benefits and relay information to the patient in a timely manner.
JOB DUTIES Duties
1. Verify and interpret patient insurance benefits
2. Communicate with insurance plans as needed for payment retrievals, changes, denials, and conflicts
3. Request pre-certifications 2 weeks before surgery and follow up daily until pre-cert is obtained
4. Contact patient at least 72 hours ahead of surgery to notify them of fees due prior to surgery
5. Document fees due in EPM
6. Maintain current information in NextTech regarding each plan and patient data
7. Scan and file documents
8. Counsel patients regarding financial options
9. Seek all available avenues of patient benefits including secondary, tertiary, indigent care as applicable
10. Receive incoming patient calls regarding CCLSC benefits
11. Return patient calls in a timely manner
12. Be able to send task
13. Document all patients’ calls
14. Perform other duties incidental to the work described herein %of Time(must add up to 100%):
100%
KNOWLEDGE, SKILLS, AND ABILITIES • Able to independently seek out resources and work collaboratively
• Ability to establish and maintain effective working relationships
• Able to communicate clearly with patients, families, visitors, healthcare teams, physicians, administrators, leadership and others
• Able to teach patients and families in accordance with the plan of care
• Able to use sensory and cognitive functions to process and prioritize information
• Able to use fine motor skills
• Able to use computer and learn new software programs
• Able to withstand prolonged standing and walking
• Able to remain focused and organized
• Understands and follow position guidelines and timelines
• Knowledge of applicable insurance plans
• Able to maintain financial compliance and successful revenue recovery by consistently applying workflows as defined in the position check-list
• Able to prioritize and manage multiple duties
• Able to calculate and clearly communicate patient fees relative to insurance and patient amounts
• Able to read, analyze, interpret patient chart/accounts, insurance websites or publications, internal reports, emails, faxes, or other related communication to this position
• Working knowledge of Nextech templates
PROFESSIONAL EXPECTATIONS • Maintains patient confidentiality at all times according to HIPAA standards
• Represents the organization in a positive and professional manner
• Accepts responsibility, recognizes decisions and communications represent the facility and are subject to state, federal and regulatory agencies
• Demonstrate critical thinking skills and sound judgment in decision making and communication
• Adherence to the Employee Handbook to assist in day to day self and personnel activities
EDUCATION REQUIREMENTS/
PREFERENCES Work requires an education background generally equivalent to a high school education.
EXPERIENCE REQUIREMENTS/PREFERENCES 1 year experience working with insurance companies
LICENSURE/ CERTIFICATION REQUIREMENTS CPSS Certification
WORKING CONDITIONS Must be able to work under pressures in a busy clinic/office environment.
Must by present on site for entire shift.
Must participate in group activities requiring interpersonal skills and cooperation.
Must work as a late person when scheduled or according to business needs
Must be able to react quickly and immediately respond to emergencies
Must travel between locations on needed basis.
Must be able to handle multiple assignments, conflicting demands & priorities.
Must maintain attention to detail over extended period of time.
Must be continually aware of variations in changing situations.
Must be able to move throughout office environment throughout day.
Must be able to lift ___ lbs.
Must be able to push/pull ___lbs.
Must be able to carry ___ lbs.
Must be able to reach for objects by extending arms.