Patient Access Representative & Insurance Specialist – Women’s Pelvic & Reconstructive Center

Patient Access Representative & Insurance Specialist – Women’s Pelvic & Reconstructive Center

Requirements

• At least five years medical collections experience.
• At least three years working knowledge of CPT and ICD-10 coding standards.
• Comprehensive knowledge of clinical registration, patient accounting, billing, reimbursement and third party payer/managed health care procedures and practices.
• Knowledge of clinical departments and operational relationships.
• Knowledge of and ability to use CPT and ICD-10 coding standards.
• Understands advanced level of medical office terminology.
• Skilled in analyzing accounting, billing, coding, and third party payer reports.
• Ability to perform mathematical computations and compute ratios and percentages.
• Skilled in defining problems, collecting data, interpreting billing information.
• Skilled in using medical software computer applications.
• Ability to organize work for the highest level of efficiency.
• Ability to communicate clearly and be self motivated.
• Ability to develop and maintain positive, effective relationships with patients and staff.

Responsibilities

• Obtain prior authorization and insurance benefits and must be completed three days in advance of appointments.
• Enter or scan all actions related to the patient’s account into an electronic medical record including the prior authorization forms submitted to insurance companies when they are faxed for authorization.
• Obtain physician referral prior to treatment.
• Review upcoming appointments 30 days before scheduled services to obtain benefits verifications and referrals for treatment.
• Collect deposits, deductibles and/or co-pays from the responsible party. Work with patients to make financial arrangements.
• Respond to patient requests regarding information on their account. Explain financial policy and procedures as needed.
• Respond promptly to payer (insurance company, employer, etc.) calls and correspondence related to patient services and claims.
• Input benefits and prior authorization as well as insurance information for claims to ensure prompt and accurate billing. Work to resolve coding or billing errors in order to effect accurate reimbursements and minimize patient liability.
• Complete all necessary forms and medical documentation, as necessary, for copay programs available through the drug companies. Submit required forms and documentation for prompt payment.
• Coordinate with other staff to seek patient account resolutions.
• Follow up on unpaid and underpaid claims to effect complete reimbursement by the year/patient. Coordinate with billing/collections team to resubmit or correct and submit claims or submit appeals, as required.
• Audit all patient account transactions for accuracy and resolve any outstanding issues. Identify and correct billing errors.
• Communicate with manager, clinical staff and physicians regarding outstanding issues related to patient accounts.
• Use approved collection correspondence and/or calls to patients to effect collection of patient responsibility.
• Audit all patient credit balance accounts for resolution.
• Make recommendations to the manager concerning accounts to be passed to third-party collection or to be adjusted as uncollectible.
• Audit all patient account transactions for accuracy and resolve any outstanding issues.
• Identify and correct billing errors.
• Check daily the payments posted by Athena for accuracy.
• Contact patients after authorizations are obtained to explain benefits and coordinate payments for to the first appointment.
• As needed, notify manager when office supplies are needed and scan packaging slips to appropriate departments.
• Participate in educational and developmental activities.
• Attend meetings as requested.
• Perform other duties as directed by the supervisor.

Preferred Qualifications

• Some college preferred