Company :Allegheny Health NetworkJob Description : 

GENERAL OVERVIEW:

This job completes one or more of the following processes (scheduling, pre-registration, financial clearance, authorization and referral validation and pre-serviceability estimations and collections) within Patient Access and creates the first impression of AHN's services to patients and families and other external customers. Articulates information in a manner that patients, guarantors and family members understand so they know what to expect and have an understanding of their financial responsibilities. Assumes clinical and financial risk of the organization when collecting and documenting information on behalf of the patient. Assists with onboarding new hires to the department and acts as a subject matter expert to support as needed.

ESSENTIAL RESPONSIBILITIES

Conducts scheduling, and preregistration functions, validates patient demographic data, identifies and verifies medical benefits, accurate plan code and COB order. Obtains limited clinical data based on service required. Corrects and updates all necessary data to assure timely, accurate bill submission. (20%)Verifies insurance information through payor contacts via telephone, online resources, or electronic verification system. (20%)Identifies all patient financial responsibilities, calculates estimates, collects liabilities and post payment transactions as appropriate in the ADT system and performs daily reconciliation. Identifies self-pay and complex liability calculations and escalates account to the Financial Advocacy Department as appropriate. (20%)Delivers positive experience and superior customer service when interacting with all patients, AHN leadership and staff, physician offices and designated external agencies or vendors. Performs any written or verbal communication necessary to exchange information with designated contacts in a positive and effective manner. (10%)Assists with onboarding new hires to the department, and acts as a subject matter expert to support team as needed. Engages team with registration and payor related changes to ensure understanding and compliance. Assists department leadership with problem solving related issues as requested. (10%)Maintains focus on attaining productivity standards, recommending new approaches for enhancing performance and productivity when appropriate. (5%)Accountable for following all downtime procedures during a system downtime, and completing an accurate registration when the system recovers in a timely manner. (5%)Adheres to AHN organizational policies and procedures for relevant location and job scope. Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes. (5%)Communicates team barriers, process flow or productivity issues to department leadership, while taking the initiative to participate in problem solving activities. (5%)Performs other duties as assigned or required.

QUALIFICATIONS:

Minimum

High School/GED

2 years in the Healthcare Revenue Cycle, preferably within a financial clearance setting 

Excellent Customer Service and Communication SkillsOperating PC and using software applications

Preferred

Associate's DegreeCall Center experience 3 years of relevant experience

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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