Trinity Health Patient Service Rep. in Howell, Michigan
works at both Livingston and Brighton, every other weekend required (shift may vary), rotating holidays required (shift may vary), on call required (in addition to scheduled hours)
Under limited supervision; determines need for and obtains authorization for treatment /procedures and assignment of benefits required. Provides information to patients concerning regulatory requirements. Provides estimated costs and patient responsibility, facilitating collection of co-pay, deductible and private pay balances. Responsible for the complete and accurate collection of patient demographic and financial information for the purpose of establishing the patient and service specific record for claims processing and maintenance of an accurate electronic medical record. Registers and checks-in patients and determines preliminary patient and insurance liability. Performs account analysis, problem solving and resolution of patient account issues. Initiates billing and rebilling of accounts as appropriate.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Interviews patients and gathers information to assure accurate and timely claims submission. Interprets information collected to determine and create comprehensive visit-specific billing records. Determines need for and obtains authorization for treatment/procedures and assignment of benefits as required. Maintains competency by participating in on site and external training opportunities. Utilize skills gained from training sessions to improve and enhance their work processes and customer interactions. Provides information to patients concerning hospital policies and regulatory requirements utilizing effective interpersonal and guest-relations skills. Provides assistance to other Health System or physician offices staff regarding registration, insurance verification and authorization requirements and processes. Determines appropriate payment required at point of registration (deposits, co-pays, minimum charges and non-covered services.) Collects payment at time of registration or check-out. Based on planned services provides estimated costs and patient responsibility for both procedural and complex services. Documents communication with patients related to estimates within the patient accounting record. Verifies procedural and diagnosis codes submitted by service departments and physicians to assure accuracy for claims submission and adjudication of reimbursement. Verifies insurance eligibility with payors. Determines benefits and ensures authorization requirement are met. Interacts with ordering practioner and patient to coordinate service and insurance requirements. Contacts patients to discuss eligibility and benefits and requirements specific to clinical services. Creates appropriate registration record. Communicates with patients their financial responsibility, benefit and authorization status prior to clinical services. Facilitate cash collection as appropriate prior to and at the time of service, including copays, deductibles, and private pay responsibility. Obtains insurance authorization, patient liability acknowledgement, acknowledgement of non-covered services and advance beneficiary notices and consent forms. Explains the purpose of these forms to patients and responds to question related to their intent. Completes as required; obtains signatures and approvals; verifies that information is complete and accurate. Is proficient at the use of automated tools and makes appropriate decisions related to the relationship of the action required and the tool used. System tools include: HealthQuest Patient Management and Patient Accounting, Cerner Enterprise Scheduling, Pathways Compliance Advisor (medical necessity screening), Reg Assist (scanning patient documents) EMDEON (eligibility verification, copays), UGS (Medicare), WebDenis (Blue Cross), HAP, Priority Health, NaviNet (Aetna, Cigna), Champs (Medicaid) Community Health Plan (WHP), Iexchange (BCN authorizations), American Imaging (radiology authorizations). Works various reports to ensure accuracy and completion of records to facilitate clean claims submission. Responds to contacts from from Medical Records, Clinical Departments and PFS Teams to ensure appropriate analysis, error correction and process identification in relation to concerns and issues. Reviews, analyzes and corrects system error reports (C9, Reg Error, Cancellation, MSP Bypass etc.) Utilizes Scheduling Booking Reports , Stop/Go Reports, Schedules, to facilitate daily patient activity and flow in support of the clinical departments. Analysze completeness and accuracy of records on these reports proactively and take action as appropriate. Demonstrates understanding and follows prevailing regulatory or 3rd party requirements (MSP, pre-certification, consent forms, HIPAA etc.) Analyze and problem-solves issues related to revenue cycle elements (charges, demographic information, guarantor information, insurance eligibility, coordination of benefits, authorization requirements) in response to patient inquiries and issues. Works to resolves these issues in a timely and appropriate manner including assisting with submission of patient centered claims to insurance carriers. Explains accounts to patients and translates registration and billing issues to patient understanding. Identifies opportunities to improve the quality of registration, billing or verification procedures. Responds to patient questions concerning insurance coverage, benefit coverages for their insurance plans. Demonstrates accountability to follow-up with patients concerning requests for information or action regarding their account. Knows where to obtain information to assist PFS team members, patients, internal and external customers. Assists patients or physician office staff by referring to the appropriate sources of information. Demonstrates team-player abilities and seamless service to patients. Occasionally assist with training of new employees and cross training of other team members. Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution. Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors to St. Joseph Mercy Hospital. Discusses patient and hospital information only among appropriate personnel in appropriately private places. Behaves in accordance with the Mission, Vision, and Values of Saint Joseph Mercy Health System. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
OTHER FUNCTIONS AND RESPONSIBILITIES
Performs other duties as assigned.
REQUIRED EDUCATION, EXPERIENCE AND CERTIFICATION/LICENSURE
Requires high school diploma or equivalent.
CHAA certification from National Associate Healthcare Access Management preferred.
One or two years related experience.
REQUIRED SKILLS AND ABILITIES
Demonstrated computerized system application experience. Critical thinking and problem-solving skills. Analytical ability to affective and efficiently resolve registration, insurance and claims processing issues. Demonstrated knowledge of revenue cycle processes and terminology. Interpersonal skills to effectively communicate with patients, team members, clinical colleagues, medical staff, third party providers, and external agencies and contacts. Exceptional customer service skills and positive personality attributes. Patience in dealing with ordinary, arduous or emotional patients. Use of telephones.
Job Number: 00094827
Location: Howell, MI
Organization Name: Saint Joseph Mercy Health System
Facility: SJSEMI - SJMHS Livingston Hospital
Employment Type: Part time
Shift: Day Shift