GENERAL SUMMARY OF DUTIES
Responsible for timely and accurate pre-registration and insurance verification. Accurately interprets managed care contracts and is proficient in the use of the Contrak system.
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
- Retrieve reservation/notification of scheduled admission from gatekeeper via laser printer
- Perform pre-registration and insurance verification within 24 hours of receipt of reservation/notification for both inpatient and outpatient services
- Follow scripted benefits verification and pre-certification format in Meditech custom benefits screen and record benefits and pre-certification information therein
- Contact physician to resolve issues regarding prior authorization or referral forms
- Assign Iplans accurately, via the use of the Contrak system
- Perform electronic eligibility confirmation when applicable and document results
- Research Patient Visit History to ensure compliance with the Medicare 72 hour rule
- Complete Medicare Secondary Payor Questionnaire as applicable for retention in Abstracting module
- Calculate patient cost share and be prepared to collect via phone or make payment arrangement
- Contact patient via phone (with as much advance notice as possible, preferably 48 hours prior to date of service) to confirm or obtain missing demographic information, quote/collect patient cost share, and instruct patient on where to present at time of appointment
- Receive and record payments from patient for services rendered.
- Utilize Meditech MOX communication system to facilitate communication with hospital gatekeeper
- Perform insurance verification and pre-certification follow up for prior day's walk in admissions/registrations and account status changes by assigned facility
- Communicates with hospital based Case Manager as necessary to ensure prompt resolution of pre-existing, non-covered, and re-certification issues
- Utilize Meditech account notes and Collections System account notes as appropriate to cut-n-paste benefit and pre-authorization information and to document key information
- Meets/exceeds performance expectations and completes work within the required time frames
- Implements and follows system downtime procedures when necessary
- Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"
- Other duties as assigned
KNOWLEDGE, SKILLS & ABILITIES
- Communication - communicates clearly and concisely, verbally and in writing
- Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
- Interpersonal skills - able to work effectively with other employees, patients and external parties
- PC skills - demonstrates proficiency in PC applications as required
- Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems
- Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately
- At least three years of insurance verification experience preferred
PHYSICAL DEMANDS/WORKING CONDITIONS
Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 25 pounds occasionally. Work is performed in an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.