Representative – Patient Access 

Job Description

REQUIREMENTS

• High school diploma /GED or equivalent working knowledge.
• Requires knowledge of one or more of the following: patient financial services or collecting service processes normally acquired over up to two years of work experience.
• Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently.
• Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences.
• Strong knowledge in the use of common office software, word processing, spreadsheet, and database software are required.

PREFERRED

• Work experience with the Company’s systems and processes is preferred. Previous cash collections experience is preferred. Additional related education and/or experience preferred.

RESPONSIBILTIES

• Confirm valid coverage for services and location by contacting insurance companies and/or review electronic responses for benefit information
• Manage patient insurance demographic information to verify authorization obligations.
• Verify that service is a covered benefit, based on knowledge of the specific insurance plan, the specific benefit package restrictions, and the timing of the service
• Understand patient deductibles, out of network referrals and out of pocket limitations.
• Review the account and timing of last patient demographic query to identify missing standard and/or required information. If necessary, contact the patient to complete the information.
• Calculate and collect patient liability before or at the time of service. Communicate the liability and explain the calculation low and high amounts when necessary.
• Identify the potential need for assistance when the coverage/benefit is either inadequate or nonexistent for a medically necessary service, and if necessary, create a payment plan with the patient and document the agreement appropriately.
• Answer automated call center calls and determine whether an outbound call is necessary, either to the patient or to the insurance company. For a call back, assess the call and respond appropriately, attempting to resolve all patient inquiries
• Builds strong working relationships with assigned business units, hospital departments or provider offices. Identifies trends in payment issues and communicates with internal and external customers as appropriate to educate and correct problems. Provides assistance and excellent customer service to these internal clients.
• Responds to incoming calls and makes outbound calls as required to resolve billing, payment and accounting issues. Provides assistance and excellent customer service to patients, patient families, providers, and other internal and external customers

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