Insurance Claim Representative Jobs in Rhode Island

SUMMARY:General supervision but according to established credit policies and procedures, interviews and registers patients for Emergency/Trauma Center or Ambulatory treatment by obtaining demographic, third-party insurance and related financial information, entering same to on-line computer system. Completes third-party documentation, discusses any existing balances for previous Hospital services rendered and makes preliminary determination on welfare eligibility. Request cash deposit approximating charge for scheduled services or co-insurance if applicable, and/or the co-payment required by third party coverage for clinic visits and outpatient ancillary service. Arranges payment terms. Contacts Patients Accounts Advocate, when applicable. Determines eligibility for free service when necessary.Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:Instill Trust and Value DifferencesPatient and Community Focus and CollaborateRESPONSIBILITIES:Competes Hill-Burton application when patient lacks evidence of adequate health insurance coverage, according to established criteria for provision of uncompensated hospital services. Requires patient to sign statement of financial responsibility. Assists patient to apply for welfare coverage, if no coverage is obtained or if can not pay. Determines eligibility for Rhode Island Hospital free service for clinic visit only, using sliding scale and based on established guidelines for same.Advises Senior Patient Advocate of patients lacking health insurance coverage and/or sources of income sufficient to reimburse Hospital for services rendered.Completes documentation required to initiate commercial insurance, Workers' Compensation and/or CHAMPUS claims.Verifies third-party insurance plan numbers and benefit level. Documents all information obtained in PMAS accounting notes. Contacts insurance carrier when necessary to obtain treatment authorization and co-payment information.Obtains authorization for treatment from health maintenance organizations, verifying coverage as needed.Discusses existing Hospital account balances and arranges payment schedule for same. Requests evidence of coverage or requested payment ranging from partial to full cost for clinic visit or entire treatment series. Requires completion of Financial information to make payment arrangements when patient unable to pay entire amount. Upon determination that a liability claim exists, completes lien form and notes in PMAS accounting file.Collects cash/credit card payment for Outpatient/Emergency/Trauma services when possible.Posts payments to specific general ledger account.Prepares bank deposit for pickup by cashier twice daily.Determines priority of health insurance coverage.Registers all patients on-line by entering appropriate data to computer system via terminal. Embosses identification card in order to initiate or update patient Hospital record. In ambulatory registration, registers all patients for PAC Operating Room, clinics and ancillary areas. Takes APC Operating Room bookings and initiates all charge vouchers for out-patient procedures In Emergency Department registration, notifies appropriate security agency of emergency treatments resulting from assaults, gunshot wounds, animal bites, accidents and the like, according to Rhode Island State Department of Health regulations.Follows up on third-party documentation from Private Physician' offices and other hospital off-hour ancillary areas.MINIMUM QUALIFICATIONS:BASIC KNOWLEDGE:A level of knowledge generally obtained through completion of High School with additional math and computer courses.Well developed interpersonal and communication skills in order to obtain patient information and deal effectively with the public at point of contact.Persuasive collection techniques. Ability to tactfully set payment arrangement terms and collect money.Full knowledge of third party health insurance claims processing, coverage and documentation requirements.Math skills and the ability to operate on-line computer terminal.Acquired knowledge of Accounting Department patient billing systems.EXPERIENCEix to twelve months of previous clerical support experience is required, preferably in a setting that demonstrates ability to function effectively in high-volume clinics.Previous experience with on-line data entryccess system required.WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:Working conditions are generally good, little discomfort due to noise, heat, and dust.SUPERVISORY RESPONSIBILITY: None.

Pay Range:

$21.90-$22.91

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location:

Rhode Island Hospital - 593 Eddy Street Providence, Rhode Island 02903

Work Type:

24 Hour 4:00P-12:30A a rotating every other weekend and holiday. WK1 Mon, Wed, Sat WK2 Sun, Wed, Thurs

Work Shift:

Evening

Driving Required:

No

Union:

International Brotherhood Teamsters