- Interviews patients (face-to-face/phone/via document) and utilizes multiple complex applications to create (or validate existing) patient medical record and insurance/bill claim using demographic and insurance information.
- Mastery of skills relating to insurance coverage, benefits, rules & regulations and allocation of plans accurate information and fulfillment of requirements resulting in expected payment for services
- Verifies and allocates insurance plans utilizing electronic eligibility tools, phone calls payer, accesses web portals and initiates appropriate action for services including non-covered and out-of-network insurance services
- Executes patient estimate, educates guarantor regarding charges and out-of-pocket liability and establishes payment plan when applicable for professional and technical services.
- Successfully calculates, collects and posts co-pays, deductible, co-insurance and prior balance due from patient in accordance with policy; meets or exceeds collection targets and productivity standards. Takes appropriate steps to balance and secure cash in accordance with UH policy.
- Takes steps to prevent medical record duplications or incorrect patient selection imperative to patient safety; safeguards Protected Health Information (PHI).
- Contacts physician or other clinical provider to validate / clarify information on orders, schedules, or other requirements such as patient instructions.
- Utilizes electronic reports, worklists, and queues to identify claims requiring updating; makes corrections as needed to ensure accurate and timely billing.
- Schedules professional and technical patient appointments using multiple software applications.
- Verifies insurance benefits/coverage using electronic eligibility tool / phone call; initiates appropriate action to complete a Notice of Admission (NOA).
- Completes daily reconciliation of the Important Medicare Message (IMM) and Medicare Secondary Payer Questionnaire (MSPQ) in accordance to Government regulations.
- Completes daily status changes and revisions in conjunction with the Utilization Management Team.
- Scans and retrieves appropriate related documents in scanning applications
- Projects positive image to all UH patients, physicians, and customers (internal and external) as the first impression of University Hospitals.
- Communicates using prescribed customer service focused greeting and scripting to achieve branded UH patient experience.
- Follows department policy and procedures, attends and participates in corporate and local team meetings and maintains patient / physician confidentiality.
- Maintains emergency disaster preparedness knowledge/skills.
- Effectively communicates utilizing telephone, emails, or correspondence for internal and external customers.
- Maintains emergency preparedness knowledge/skills needed to participate in drills / disaster exercises and real time safety events.
- Participates in wayfinding; provides directions or transport as needed to ensure positive patient / customer experience.
- Performs other related duties as assigned and participates in enterprise special projects as needed.
- Performs other duties as assigned.
- Complies with all policies and standards.
- For specific duties and responsibilities, refer to documentation provided by the department during orientation.
- Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.
- High School Equivalent / GED Required
- 1+ years of healthcare or customer service experience Required and
- College associate or bachelor's degree is equivalent to 1 year of work experience. Required and
- Experience utilizing multiple complex software solutions Required
- Dependable to work in this 24/7/365 department with willingness to travel to other sites and locations throughout the enterprise including possible overtime. Required
- Notable client service, communication and relationship building skills. Required
- Must have ability to perform in a fast-pace and stressful environment (such as the Emergency Department). Required
- Demonstrates ability to function independently and as a team player in a fast-paced environment. Required
- Must have strong written and verbal communication skills. Required
- Professional demeanor Required
- Detail-oriented and organized, with good analytical and problem solving ability Required
- Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, multi-line phone, FAX machine, etc.) Required
- Standing Occasionally
- Walking Occasionally
- Sitting Constantly
- Lifting Rarely 20 lbs
- Carrying Rarely 20 lbs
- Pushing Rarely 20 lbs
- Pulling Rarely 20 lbs
- Climbing Rarely 20 lbs
- Balancing Rarely
- Stooping Rarely
- Kneeling Rarely
- Crouching Rarely
- Crawling Rarely
- Reaching Rarely
- Handling Occasionally
- Grasping Occasionally
- Feeling Rarely
- Talking Constantly
- Hearing Constantly
- Repetitive Motions Frequently
- Eye/Hand/Foot Coordination Frequently
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Description
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Essential Functions
QualificationsEducation
