Patient Access Representative I - Insurance Verification Representative

Prior to patient appointments, this position contacts patient’s insurance plans to confirm coverage and eligibility. Ensures that registration is complete and accurate which includes demographic/biographical data as well as insurance information. These activities are to ensure reimbursement for provider services.

Responsibilities

Prior to patient appointments, contacts patient's insurance plans to confirm coverage and eligibility; Ensures that registration is complete and accurate including demographic/biographical data and insurance information; Obtains co-pay information, verifies that services will be In/Out of Network, and updates system for anticipated services; Ensures completion of financial documentation in accordance with credit and collection policies; Interacts with physicians' office staff to secure insurance information which may include referral or authorizations that may be required; Performs patient registration activities to ensure accurate financial and biographical data; Documents all notification, authorization and eligibility information in the registration systems; Provides self-pay patients with cost estimates on scheduled services prior to their appointments; Adheres to TMCH organizational and department-specific safety, confidentiality, values policies and standards; Performs related duties as assigned

Requirements

High School diploma or General Education Degree (GED), or an equivalent combination of relevant education and experience; No licensure or certification required; Knowledge of office management practices, including billing and scheduling within healthcare; Knowledge and understanding of insurance plans (i.e. HMO, POS, PPO etc.) and of government and commercial payors overall; Ability to read or listen and comprehend simple instructions, short correspondence, and memos; Ability to write, document and make note of findings; ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization; Ability to read and interpret documents such as safety rules, procedure manuals, and governmental regulations; Ability to effectively present information and respond to inquiries or complaints from clinic staff, coworkers and the general public; Ability to apply common sense understanding to carry out simple/detailed written or oral instructions; Basic computer familiarity and experience and the ability to operate basic office equipment

Nice to have

Completion of vocational medical office training desired; Preferred six (6) months of medical office and/or hospital experience to include healthcare eligibility and benefit analysis or appointment scheduling experience