POSITION SUMMARY:

The Financial Clearance Center Admission Associate coordinates and assists in the completion of all activities relating to an inpatient, observation or outpatient (scheduled procedures or surgeries) account’s financial security, including components of  insurance verification, identifying and collecting financial responsibility while the patient is in house or prior to date of service.  Insurance verification may include eligibility and benefits verification, obtaining authorization and patient liability generation. Responsible for Payer Notification of Admission or Observation within payer guidelines to avoid denials of non-notification. The staff member performs activities including but not limited to;  a complete and accurate registration, providing a patient estimate, and complete account documentation that will expedite a smooth and timely billing and collection process, while adhering to department policies and procedures.

 

EDUCATION/CERTIFICATION:

Must have a High School diploma or GED equivalent

 

EXPERIENCE:

1-2 years of customer service experience Computer skills, including but not limited to Microsoft® Word and Excel Collections background strongly preferred

 

COMPETENCIES:

Good customer service and organizational skills, including excellent verbal English communication abilities. Medical terminology and knowledge of third party billing practices is helpful. Basic computer and keyboard required.

 

ESSENTIAL DUTIES and RESPONSIBILITIES:

Disclaimer: Job descriptions are not intended, nor should they be construed to be, exhaustive lists of all responsibilities, skills, efforts or working conditions associated with the job.  They are intended to be accurate reflections of the principal duties and responsibilities of this position.  These responsibilities and competencies listed below may change from time to time.

 

Job-Specific Competency

Performs insurance verification on primary and secondary payers for all inpatient, Outpatient scheduled procedures or surgeries, observation and high-dollar outpatient accounts, as defined by Financial Clearance Center scope.  Non-scheduled insurance verification includes ensuring that the policy is effective, benefits are documented, and notification of admission has been delivered to the payer. Completes Notification of admissions (NOA) to insurance companies to ensure timely notification within insurance specific guidelines to obtain initial admission authorization Ensures necessary authorization are obtained for scheduled admissions, surgeries or hospital services. Ensures that account is in appropriate status as per Medicare guidelines and/or physician order. Works with Case Management on Inpt / obs status changes while patient is inhouse to ensure accurate status. Communicates to Care Management the need for clinical documentation to obtain authorization.                 Works with Patient Financial Services on authorization denials related to NOA or scheduled services Maintains working knowledge of insurance regulations to determine payer requirements and also stays informed of general information required for third-party liability and worker’s compensation.                                             Edits accounts to be sure that all pertinent information, including Subscriber and Admit Source/Priority, is accurate to expedite billing. Documents process of actions and steps taken to obtain necessary information in order to assist in timely billing as well as any follow up action necessary. Processes all Medicare, HMO, and commercial claims and informs Manager of any potential reimbursement problems discovered during notification process.                                    Works closely with Financial Counseling to address the needs of the uninsured patient as well as to identify any self pay patient balances. Works with patients to capture any necessary paperwork upon admission to the hospital. Identifies and collects estimated patient obligations while patients are still in house or prior to scheduled procedure/surgery. Pre-registers all scheduled inpatient and high-dollar outpatient accounts, as defined by Financial Clearance Center scope.  Identifies patient liability for scheduled procedures/surgeries, provides estimate of services and collects (at determined % of opportunity in KPI) prior to date of service. Assists with other items as requested by the Supervisor.