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.
SUPERVISOR - Lead Pre-registration/Insurance Verification Representative
SUPERVISES - N/A
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
AGE OF PATIENTS SERVED:
This position requires competence in assessment, treatment, and/or care for the age groups indicated. The staff member must be able to demonstrate the knowledge and skills necessary to provide care, based on physical, psycho/social, educational, safety, and related criteria, appropriate to the age for the patients served in his/her assigned service area. The skills and knowledge needed to provide such care may be gained through education, training or experience.
Age Groups: Birth - 1 year (infant), 1 - 11 years (pediatric), 12 - 16 years (preschooler), 17 - 64 years (adult),
65 - Life Span (geriatric)
High school diploma or GED required
At least three years of insurance verification experience preferred
CERTIFICATE/LICENSE - N/A
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 50 pounds occasionally. Work is performed in an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people.
A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom